Journal of Hospital Medicine Because It Matters

An old man and a young boy walk along a beach, with the old man throwing stranded starfish back into the ocean. The boy asks, Why bother tossing them back when you know they'll just keep washing up? To which the old man replies, after casting another starfish into the water, Because it matters to that one.

The Starfish Story, based upon an essay by Loren Eiseley

Most patients seem not to notice it. Occasionally I'll have a patient who, with comedic license, overlooks the stipples and wavy edges and jokingly asks, What are you, a 1‐star general?

I'm referring to the gold starfish pin I wear on the left lapel of my white coat. Where I trained, all Medicine interns receive one on the first day of internship, in tribute of the much‐celebrated story above. The purpose of the pin is simple: to remind us that no matter how tired, frustrated, or overwhelmed we sometimes feel in medicine, we can always make a difference in the life of the patient in front of us.

The older I get the more I've come to appreciate that the starfish tale ‐ inspiring as it is ‐ reminds us of only half the story. As we all know, patients don't exist in isolation. They have brothers and sisters, mothers and fathers, sons and daughters, friends and lovers. In the middle of the night, or from under a pile of paperwork, it can be even harder to remember that what we as healthcare professionals do for our patients matters to these people, too. For this latter reminder, I turn to my hospital chapel.

For those who know me this might come as a surprise. I'm spiritual, but not very religious, and while I often reflect on what's going on in my life or the lives of my loved ones, I usually don't feel the need to go to a sanctuary to do it. I'm not sure why I visited the chapel that first time.

Located behind 2 unadorned double doors off the main hallway, my hospital chapel looks from the outside like any other room in the building. Similarly, on the inside it looks like any other chapel ‐ dimly lit, with an altar, a Bible, pews, and an electric organ. What makes this space special for me is the volume that rests on a podium opposite the altar, under a bright fluorescent lamp and a sign that reads, This book is for your prayer requests. Please write down whatever helps you.

On the days when I feel overwhelmed with patient care, in addition to glancing at the starfish pin on my lapel I think of the prayer request book. Open for all to read, the book is a place where people can share their hopes and fears, about themselves or loved ones, with others who may or may not be complete strangers. Most people write about ill loved ones. What they have to say is profoundly moving and can only be done justice in their own words (with names and other details altered to protect confidentiality).

Some people write about letting go, about redirecting care from attempts at cure to comfort. Their anguish, like the indentation from their pen, is palpable. Dear God, our mom is almost 91 years old, says one person. She's been sick and hospitalized about 7 times or so. We really don't want her to leave us, but[w]e know she has had enough pain and wants to join our dad. Another person reflects, Dear God, my sister Pat is on the 4th floor. I know today I will take her off the vent. Please take her hand. Show her the way if that's Your will.

Others write about specific procedures or illnesses. In the jagged hand of a 10‐year‐old, a child prays for my mother, Mary, because she is getting a spinal tap right now and I want her to get well, which he then signs with a large heart and Love you, Mom. Someone else writes, Dear God, I need Your healing touch for my dad, who has lung cancer. Then, as if an afterthought, Also for me, because I have to have a colonoscopy this weekend.

Although many of the entries are addressed to God, a considerable number are directed toward anyone reading the book. Please pray for my dad, implores one person in an earnest hand. He was in a bad accident. I just want him to get better. He makes everything better. I just want my dad back. Is that selfish? Please pray for him. One of the most heart‐wrenching requests is from a new mother hoping for a second chance: My newborn son is here in the NICU. Please pray he is alrightand that they (the social workers) give me the next 18 or so years to make up for what I've done to him. Please, I want another chance to be the good mother I know he needs.

Every few months, the prayer request book fills up with hopes and fears just like these, including ‐ if it's not refreshed quickly enough ‐ the inside of the front and back cover. More meaningful than anything I could ever pin to my white coat, each entry is a powerful reminder of how we as healthcare providers affect more than just our patients. Indeed, for better or for worse, the stakes are much higher than that. What we do also matters to the people to whom our patients matter.

The people who penned the preceding entries are among those I see walking down the hall, riding with me in the elevator, standing in line next to me in the cafeteria, and sitting at my patients' bedsides. They could be anyone, and so they are everyone. In honor of them all I share this entry of my own: Thank you for opening up your hearts. Thank you for helping me remember how privileged I am to be a physician, and how, through helping one, I help more than one.

An old man and a young boy walk along a beach, with the old man throwing stranded starfish back into the ocean. The boy asks, Why bother tossing them back when you know they'll just keep washing up? To which the old man replies, after casting another starfish into the water, Because it matters to that one.

The Starfish Story, based upon an essay by Loren Eiseley

Most patients seem not to notice it. Occasionally I'll have a patient who, with comedic license, overlooks the stipples and wavy edges and jokingly asks, What are you, a 1‐star general?

I'm referring to the gold starfish pin I wear on the left lapel of my white coat. Where I trained, all Medicine interns receive one on the first day of internship, in tribute of the much‐celebrated story above. The purpose of the pin is simple: to remind us that no matter how tired, frustrated, or overwhelmed we sometimes feel in medicine, we can always make a difference in the life of the patient in front of us.

The older I get the more I've come to appreciate that the starfish tale ‐ inspiring as it is ‐ reminds us of only half the story. As we all know, patients don't exist in isolation. They have brothers and sisters, mothers and fathers, sons and daughters, friends and lovers. In the middle of the night, or from under a pile of paperwork, it can be even harder to remember that what we as healthcare professionals do for our patients matters to these people, too. For this latter reminder, I turn to my hospital chapel.

For those who know me this might come as a surprise. I'm spiritual, but not very religious, and while I often reflect on what's going on in my life or the lives of my loved ones, I usually don't feel the need to go to a sanctuary to do it. I'm not sure why I visited the chapel that first time.

Located behind 2 unadorned double doors off the main hallway, my hospital chapel looks from the outside like any other room in the building. Similarly, on the inside it looks like any other chapel ‐ dimly lit, with an altar, a Bible, pews, and an electric organ. What makes this space special for me is the volume that rests on a podium opposite the altar, under a bright fluorescent lamp and a sign that reads, This book is for your prayer requests. Please write down whatever helps you.

On the days when I feel overwhelmed with patient care, in addition to glancing at the starfish pin on my lapel I think of the prayer request book. Open for all to read, the book is a place where people can share their hopes and fears, about themselves or loved ones, with others who may or may not be complete strangers. Most people write about ill loved ones. What they have to say is profoundly moving and can only be done justice in their own words (with names and other details altered to protect confidentiality).

Some people write about letting go, about redirecting care from attempts at cure to comfort. Their anguish, like the indentation from their pen, is palpable. Dear God, our mom is almost 91 years old, says one person. She's been sick and hospitalized about 7 times or so. We really don't want her to leave us, but[w]e know she has had enough pain and wants to join our dad. Another person reflects, Dear God, my sister Pat is on the 4th floor. I know today I will take her off the vent. Please take her hand. Show her the way if that's Your will.

Others write about specific procedures or illnesses. In the jagged hand of a 10‐year‐old, a child prays for my mother, Mary, because she is getting a spinal tap right now and I want her to get well, which he then signs with a large heart and Love you, Mom. Someone else writes, Dear God, I need Your healing touch for my dad, who has lung cancer. Then, as if an afterthought, Also for me, because I have to have a colonoscopy this weekend.

Although many of the entries are addressed to God, a considerable number are directed toward anyone reading the book. Please pray for my dad, implores one person in an earnest hand. He was in a bad accident. I just want him to get better. He makes everything better. I just want my dad back. Is that selfish? Please pray for him. One of the most heart‐wrenching requests is from a new mother hoping for a second chance: My newborn son is here in the NICU. Please pray he is alrightand that they (the social workers) give me the next 18 or so years to make up for what I've done to him. Please, I want another chance to be the good mother I know he needs.

Every few months, the prayer request book fills up with hopes and fears just like these, including ‐ if it's not refreshed quickly enough ‐ the inside of the front and back cover. More meaningful than anything I could ever pin to my white coat, each entry is a powerful reminder of how we as healthcare providers affect more than just our patients. Indeed, for better or for worse, the stakes are much higher than that. What we do also matters to the people to whom our patients matter.

The people who penned the preceding entries are among those I see walking down the hall, riding with me in the elevator, standing in line next to me in the cafeteria, and sitting at my patients' bedsides. They could be anyone, and so they are everyone. In honor of them all I share this entry of my own: Thank you for opening up your hearts. Thank you for helping me remember how privileged I am to be a physician, and how, through helping one, I help more than one.

An old man and a young boy walk along a beach, with the old man throwing stranded starfish back into the ocean. The boy asks, Why bother tossing them back when you know they'll just keep washing up? To which the old man replies, after casting another starfish into the water, Because it matters to that one.

The Starfish Story, based upon an essay by Loren Eiseley

Most patients seem not to notice it. Occasionally I'll have a patient who, with comedic license, overlooks the stipples and wavy edges and jokingly asks, What are you, a 1‐star general?

I'm referring to the gold starfish pin I wear on the left lapel of my white coat. Where I trained, all Medicine interns receive one on the first day of internship, in tribute of the much‐celebrated story above. The purpose of the pin is simple: to remind us that no matter how tired, frustrated, or overwhelmed we sometimes feel in medicine, we can always make a difference in the life of the patient in front of us.

The older I get the more I've come to appreciate that the starfish tale ‐ inspiring as it is ‐ reminds us of only half the story. As we all know, patients don't exist in isolation. They have brothers and sisters, mothers and fathers, sons and daughters, friends and lovers. In the middle of the night, or from under a pile of paperwork, it can be even harder to remember that what we as healthcare professionals do for our patients matters to these people, too. For this latter reminder, I turn to my hospital chapel.

For those who know me this might come as a surprise. I'm spiritual, but not very religious, and while I often reflect on what's going on in my life or the lives of my loved ones, I usually don't feel the need to go to a sanctuary to do it. I'm not sure why I visited the chapel that first time.

Located behind 2 unadorned double doors off the main hallway, my hospital chapel looks from the outside like any other room in the building. Similarly, on the inside it looks like any other chapel ‐ dimly lit, with an altar, a Bible, pews, and an electric organ. What makes this space special for me is the volume that rests on a podium opposite the altar, under a bright fluorescent lamp and a sign that reads, This book is for your prayer requests. Please write down whatever helps you.

On the days when I feel overwhelmed with patient care, in addition to glancing at the starfish pin on my lapel I think of the prayer request book. Open for all to read, the book is a place where people can share their hopes and fears, about themselves or loved ones, with others who may or may not be complete strangers. Most people write about ill loved ones. What they have to say is profoundly moving and can only be done justice in their own words (with names and other details altered to protect confidentiality).

Some people write about letting go, about redirecting care from attempts at cure to comfort. Their anguish, like the indentation from their pen, is palpable. Dear God, our mom is almost 91 years old, says one person. She's been sick and hospitalized about 7 times or so. We really don't want her to leave us, but[w]e know she has had enough pain and wants to join our dad. Another person reflects, Dear God, my sister Pat is on the 4th floor. I know today I will take her off the vent. Please take her hand. Show her the way if that's Your will.

Others write about specific procedures or illnesses. In the jagged hand of a 10‐year‐old, a child prays for my mother, Mary, because she is getting a spinal tap right now and I want her to get well, which he then signs with a large heart and Love you, Mom. Someone else writes, Dear God, I need Your healing touch for my dad, who has lung cancer. Then, as if an afterthought, Also for me, because I have to have a colonoscopy this weekend.

Although many of the entries are addressed to God, a considerable number are directed toward anyone reading the book. Please pray for my dad, implores one person in an earnest hand. He was in a bad accident. I just want him to get better. He makes everything better. I just want my dad back. Is that selfish? Please pray for him. One of the most heart‐wrenching requests is from a new mother hoping for a second chance: My newborn son is here in the NICU. Please pray he is alrightand that they (the social workers) give me the next 18 or so years to make up for what I've done to him. Please, I want another chance to be the good mother I know he needs.

Every few months, the prayer request book fills up with hopes and fears just like these, including ‐ if it's not refreshed quickly enough ‐ the inside of the front and back cover. More meaningful than anything I could ever pin to my white coat, each entry is a powerful reminder of how we as healthcare providers affect more than just our patients. Indeed, for better or for worse, the stakes are much higher than that. What we do also matters to the people to whom our patients matter.

The people who penned the preceding entries are among those I see walking down the hall, riding with me in the elevator, standing in line next to me in the cafeteria, and sitting at my patients' bedsides. They could be anyone, and so they are everyone. In honor of them all I share this entry of my own: Thank you for opening up your hearts. Thank you for helping me remember how privileged I am to be a physician, and how, through helping one, I help more than one.