We make a living by what we get, but we make a life by what we give...

Winston Churchill

As I entered the exam room, Michelle looked up and smiled.  The despondent look of so many visits ago was gone.  In her hand was a card. Her eyes were bright and sparkled.   Before I could say anything, she handed it to me.

"Here, I want you to have this", she said.  

And she handed me a Christmas card.  

Michelle had started to see me a year and a half earlier, struggling with eosinophilic esophagitis, asthma, and hives.  Prior to seeing me, she had seen another allergist and had been unsuccessfully placed on an elimination diet without help in her symptoms.  In reality, she had a complex mixture of food AND inhalant sensitivities, and it was in June of 2008, at the height of the grass pollen season that she felt like she was chewing and swallowing glass, and the diagnosis of Eosinophilic Esophagitis was made.  We had placed her on sublingual immunotherapy (SLIT) for multiple severe inhalant and food sensitivities, modified her diet, and she was went into symptomatic remission.

And so she gave me a Christmas Card.   

The Christmas season is a wonderful time of the year in many ways, but as an allergist it is a very special time...

Because of Christmas gifts I receive from my patients.  I still don't believe it, but not only cards, but ornaments, plaques, and even Christmas stockings have graced my walls during the Holiday Season.  I am blessed.  

For those of you analytically inclined, please note that there is no medical literature or study on Christmas Cards.  A search of the PubMed data base shows only 4 articles on search, and none of these studies the phenomenon whereby doctors receive Christmas Cards.  What type of patient sends these cards? How often are they sent?  What message do they convey?   My impressions are anecdotal, but perhaps worth noting, since I have been their grateful recipient for  many years, and I can't find the least bit of discussion on the topic:  

As I study the cards I've received I've observed that most of them fall into two broad categories.  The first group are the patients that have received treatment and have felt remarkably better.  The name(s) at the bottom of the card are usually instantly recognizable to me--extremely challenging cases that have recovered sufficiently to have a quality of life they never had, or perhaps had in the distant past but never felt they could regain.  I'm not talking about people with variable asthma, or a few sinus infections--these are people who've had deep allergic disease--usually delayed onset food and inhalant allergies missed or ignored by other doctors.  The names on the cards conjure up a picture of people who were once terrified and felt helpless with their fatigue, fibromyalgia, irritable bowel syndrome, chronic severe sinusitis, etc. Their disease is better, a semblance of life has returned, and they want to share their joy with me, symbolically, 

With a Christmas Card.

But there is another group of people I have received cards from.  Once again, I usually immediately recognize the names.  But this group is particularly intriging  to me Because  in this group are people I don't feel I've helped enough. Or at all.   I haven't made their disease go away, or "cured" them in any sense of the word. In the strictest sense, I've totally failed them. 

So why in the world are they sending me a Christmas Card?  

Let's start with the obvious, and then hypothesize:  The suffering person wants his/her suffering to be alleviated.  Completely.  However, if the suffering can't be completely eliminated, but it can be transformed or refined by a companion in suffering they can absolutely trust,  then progress towards health can still be made.  The person may (with hard work) be able to transform themself from being "a disease", to a place where they feel they are a  "healthy person" with a bad illness. There is an enormous gulf between these two viewpoints, but with hard work and patience, a person can often achieve this state.    And if the allergist can partner with his/her patient, and be a companion on their journey, the patient can be extremely grateful.  They recognize they can talk to the doctor without fear of a "lecture", truly reveal their deepest worries and most intimate concerns, in an atmosphere of nonjudgement and true advocacy.  But please don't get me wrong.  I am no Mother Theresa.  I am just an allergist who is challenged and frustrated as any other doctor to care for somebody they don't see that they have helped. I sometimes get frustrated that I haven't helped someone more than I have.   But the rewards to companioning with a seriously ill patient seems sometimes to mean more to the patient than anything I can imagine.  So I try to do my best, even if I sometimes think I come up short.  

So, what was Michelle saying to me with her Christmas Card?  I think she was saying "Thanks for helping me live life to its fullest".  But, other cards I get from other patients in the second category seem to be saying "Thanks for Being There for me".  And I realize both messages are from the heart; I just hope my patients realize what these messages mean to me, and although I can often fail on both accounts, I (like my patients) keep on trying.  And that is the true spirit of Christmas.   

Later, Dude