Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Rolling boulders uphill


When my patient was incarcerated, I realized that I could still be present and caring despite challenging circumstances. 

“We found out why Ms. S. missed her treatment appointments: she’s been in jail.” 


“The ER doc wants you to call. Mr. G. is there again.” 


So begins another Monday morning in my rural oncology practice. I tabled the messages for later and went to see my first patient. A routine follow-up for stable disease quickly detoured into a serious discussion over her husband’s irregular lab results; he’d been seen in the ER over the weekend. When the ER found out that the wife already had a Monday morning appointment with me, they simply instructed the husband to tag along. I exited the room and huddled with my medical assistant over where we could squeeze in an urgent bone marrow biopsy. 


I left the couple with the M.A. to finalize the logistics and returned the call to the ER. While on hold, I messaged our social worker to ask them to follow up with the patient in jail. We needed to make sure her labs got done on time and that she was taking her oral chemotherapy.


Later that morning, I verbally walked a new patient through how to fill a medication at a pharmacy. Like many of my patients, their first encounter with the healthcare system as an adult is only with the diagnosis of cancer, made in the ER after months of symptoms they ignored until they couldn’t. In a tale I hear too often, they didn’t ever see the need for a primary care physician. 


Sometimes, if I allowed myself to, I could weep over the gaps in the system that patients fall into until they land with me upon the diagnosis of their cancer. 


Recently, I found myself telling a colleague that when it feels like rolling a boulder up an interminable hill, and my arms and legs are giving out, I remind myself that sometimes, showing up is enough. The presence of our bodies, minds, and spirits can be enough. We don’t always have to move the boulder. 


With the broken healthcare system crumbling, rural outpatient pharmacies shutting down, and labs and urgent cares intermittently closed due to staffing shortages, it’s easy to feel that the dwindling resources mean even our best is too little up against too much.  


The reality is that sometimes we can’t move the boulder due to factors outside our control, but we can sit with our backs to it and dig in our heels. Maybe some days we don’t make any forward movement, but we’re still the stopgap. We are here. We are present. 


And to our patients, sometimes that’s everything. 








This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.