I'm writing this as I see patients on a gray, muggy, early-summer morning. Two things this week have sparked some introspection on the power of family medicine.

I've mentioned before in this column¹ about my favorite author, Kurt Vonnegut, and his fictional four-dimensional aliens, the Tralfamadorians. They view all time at once, like looking at a complete mountain range in the distance, rather than a forward-marching series of moments. In fact, they pity Earthlings for only experiencing three dimensions (the fourth dimension is time).²

I've been thinking a lot about that recently — how life's moments are like “beads on a string”³ passing through our fingers. I find comfort in that; I don't think I'd want to see all time at once. I like the feeling of change, the up and down of our cumulative existence, the unknown of what's next, and the power to change it. This timeline perception allows for an appreciation of the circle of life.

Which brings me back to earlier this week.

I think those of us in health care view death differently. We have a mix of dispassion and acknowledgment, on top of humanity, when it comes to dealing with our patients' deaths. Earlier this year my college-sophomore daughter was asking my opinion on death for an upper-level psychology class she was taking, and I told her that sometimes death can be summed up for me as the final entry in a patient's medical record.

That's what I did this week. I had a visit with a patient's three adult daughters to go over my patient's autopsy report. She was a lovely lady, a teacher, who quietly dealt with and eventually lost her battle with alcohol use disorder. She died in late 2023, and the autopsy report was just finalized this week. My final entry in her medical record recorded the details of my conversation with the family.

Death and life.

About an hour later, I made the first entry in a patient's medical record: a two-day-old infant brought in by the parents to establish care. Pregnancy and delivery were uneventful. Mom and dad (both of whom are my patients, along with their other child, mom's mother, and mom's grandmother) were tired but engaged. On my exam, I noted a single transverse palmar crease. The power of family medicine revealed itself to me, as rather than doing unneeded testing and referrals for an otherwise healthy infant with a single transverse palmar crease, I remembered the dad's medical history. I asked him to show me his hand, revealing his single transverse palmar crease. “As my grandma used to say, the apple doesn't fall far from the tree,” I told them. Colloquialisms aside, I advised them that this is likely benign⁴ and warrants nothing more than close clinical follow up.

The circle of life.

As family physicians, we have the privilege of not only bearing witness to some of life's most critical moments but also actively participating in and guiding our patients through them. What an honor. No other specialty is lucky enough to do this. Like all other family physicians, at times I get fed up with metrics and RVUs and medical margins and so forth. But those are the things that keep us up at night. What really matters is what gets us up in the morning. And this week was one of those weeks where I realized I love my specialty. That's what gets me up and keeps me engaged.