The Tyranny of the Itinerary

When my wife told me it was about time for a vacation, I started to feel that old stopwatch start running in my stomach. You know, that difficult-to-describe mix of feelings: impending confusion (what will we forget this time?), obligations to patients, financial sacrifice, the tyranny of the itinerary. My mind always cogwheels back to my early years in practice, when Leslie and I would pack the kids in the car and drive all night back "home" to see our families. We could stay and eat for free, all in exchange for the entertainment from the grandchildren. It was about all the vacation we could afford.

I would worry the whole time that when I returned to practice, my patients would be gone. This was not irrational. After our first trip back to the Midwest during that initial year in practice, I did return to find my schedule empty. My referral base had the depth of a mirage, so why should I have been surprised?

Holidays cost in many ways. Consider the lack of income while away from the office, plus the ongoing overhead, plus a doctor to substitute, plus the actual cost of the vacation, plus asking someone to feed the cat and dog. But worse than that was the knowledge that I would disappoint my patients if they knew the truth: I can't relax on a vacation. ("Doc, have a great time at Disney World! You work so hard, you deserve it!")

Finally, we took a vacation somewhere besides my old bedroom at my parent's house. I honestly don't remember where we went, but I do remember being a bit giddy. To tease my teenage daughter, I bought copies of Digest of Combat Knives and Guns and Ammo to read on the plane. My young son and I bought funny hats and hand puppets, which seemed to be a good idea at the time. I have a picture of myself holding a huge rum drink with an entire fruit salad in it, the underlying caption of which reads, "I'm on vacation!"

I no longer get giddy at the thought of a vacation. I just get nervous. My most recent vacation was a cruise down the coast of Mexico from San Diego. My wife said this would be an opportunity to relax and take my mind away from treating patients. That may have been the plan, but within 24 hours, I ended up doing a Heimlich maneuver on some unfortunate guy with gristle in his throat and treating one of the captain's staff for an acute lumbar strain. The first night at dinner, after it somehow slipped out that I was a DC, a woman recited a long and detailed story of how a chiropractor cured her aunt of cancer back in 1948. That prompted the waiter to ask me to explain the difference between a chiropractor and a massage therapist. Then, at the social event that evening, I ended up cornered, listening to a radiologist drone on about his divorce and how he became disabled from severe hemorrhoids.

While lying in a lounge chair by the pool the second day out, doing some "people-watching," I made the mistake of commenting, "That woman needs orthotics," to which my wife, who was next to me, responded, "Can't you give it a rest for one week?" She was right. I was having a hard time disengaging from the office.

So I tried harder. It seemed that the best escape I could find from the chronicles of health care was in the pursuit of the games, contests, and demonstrations offered to passengers. I went on an organized tour of the kitchen, a class on how to make animal figures out of bath towels, an ice carving demonstration, and television trivia jeopardy. I even watched late-night drunken karaoke. And even though I don't gamble, I went to "slot machine school" in the casino. ("First, put your coin in the slot. Second, pull the lever. Got it?")

It worked. Soon I was looking forward to chipping golf balls through life preservers in the swimming pool. Absurd and mindless activity can be the tranquilizer of the working class - my class. Now that I'm back in the office, when a patient asks, "How was your vacation?" I answer, "Great! Let me tell you about the bean-bag-tossing contest!"