As we approach the High Holidays of Rosh Hashanah and Yom Kippur this month, I find myself becoming more reflective, particularly about what’s important in my life. Twenty years ago I was asked to complete a biographical survey for a physician newsletter about my personal interests, which included questions such as the latest book I read, my favorite movie, etc. There was one question that stood out, “What is the meaning of life?” My response, “God knows.” It occurred to me a few years later that I could delve into a better understanding of this existential question by probing my patients for their stories about what has been meaningful in their lives. You may wonder how during a 15-20 minute visit with patients I could have time for such a discussion. One cannot come out and say, “Tell me the meaning of your life,” but I felt I could approach the topic experientially. Most of my patients were well established with me so at the end of the visit, I would simply say, “I am curious; what is the most meaningful experience you have had in your life?” For brand new patients, I would say, “I would like to get to know you better. Can you share with me the most meaningful experience in your life?” Often there would be a pause, but almost everyone was able to share something personal with me. The funny thing was that visit did not seem to last any longer. The bonus to me was the satisfaction of a person confiding to me something intimate. The advantage to my patient was therapeutic listening. We developed an unspoken trust between the two of us.
So what did my patients share with me? The majority of responses were related to family. Getting married or “having a family” was the number one response from men. Most women responded that having children was their most meaningful experience in their life, and if broken down further, it was the birth of their first child that was particular noteworthy. The second most common response was surviving a serious health condition. I don’t know if this was a consequence of the setting where I asked this question, but I was impressed of the intensity of a particular health condition on a person’s well-being. For example, a woman could define her life as before and after the time she got breast cancer, or someone else would define his life before and after he had a heart attack or had bypass surgery. In some instances, patients would express thanks to me for having saved their life. (Until then, I had not realized they felt that way.)
Some of my male patients shared with me the profound experience of having fought in a war. Others found significant meaning by “finding God” or religion. Many found meaning in their work or by volunteering. Of the hundreds of people I asked this question, only two patients mentioned “money” as playing a meaningful role in their life. One mentioned money in the context that he gave his son his entire life savings so his son could attend business school. The other one was an emigrant to the U.S, who arrived with $1000, invested in real estate which became worth over $100 million. He was proud of his achievement and looked forward to giving a substantial inheritance to his three sons.
The older a patient, the more careful was the response. I asked a 95-year-old patient about what was most meaningful in his life. He was suffering from angina for which he routinely popped several nitroglycerin tablets each day. His response was that every day was meaningful because he was happy to wake up in the morning. Initially, I thought he was dodging my question, but it took a moment for me to realize what he was telling me was profound. He taught me that everyone should approach each new day as being a gift.
As we approach the Rosh Hashanah and Yom Kippur, think about what provides meaning in your life. Be prepared in case your doctor happens to pop the question to you when you least expect it!
Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.
Editing acknowledgement: Ellen Saliman
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