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A Piece of My Mind
May 21, 2019

Systole and Diastole, Strength and Openness

Author Affiliations
  • 1Department of Internal Medicine, Bellevue Hospital, NYU Langone Health, New York, New York
JAMA. 2019;321(19):1871-1872. doi:10.1001/jama.2019.5650

“Seize diastole,” my medical school professor said. The words were a clever metaphor for a life well lived. During systole, the powerful myocardium contracts, generating pressure that propels open the aortic valve. Blood flows out into the circulation.

Diastole, the process of letting go and filling up, is not as exciting. It could even be taken for granted, cut shorter and shorter. But without adequate time for diastole, there’s no blood to be thrust forward. Homeostasis crumbles. Just as the myocardium needs time to release and refill, so does the soul.

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    8 Comments for this article
    Herbert Rakatansky, MD | Clinical Professor of Medicine Emeritus, Brown University
    I suspect that Drs. Millstein and Hirsh, both acknowledged by the author, felt compensated for their "contributions" after reading this essay in a way no amount of material compensation could equal.
    A perfect metaphor
    Osvaldo Bustos, Clinical Anatomy Lecturer | Uniformed Services University, Bethesda, Maryland
    This is a wonderful essay by a highly intelligent, sensitive, gifted physician with unique writing skills. Her personal experience as a patient suffering from depression, and her subsequent recovery with the appropriate treatment, further sensitizes her to the needs of her patients. She has a brilliant future in medicine.
    Absolutely Beautiful
    Francisco Borja Ponce, MD, MPH | Clínica Borja
    As a physician, I fully identify with this article. We sometimes let our work 'absorb' most parts of our life and we forget to relax, knowing it is an important part of our wellbeing.

    The author cites some of her personal experiences that every medical student would have: struggles with life and death patients and learning how to respect, admire, and love a human life.

    Without doubt, it is an accurate, beautiful, and honest article.
    The Eluded Lesson...
    Chukwudi Nwabudike, MBBS, MD, Ph.D. | Hospital
    A very good essay, which posits the question, nevertheless, of why physicians so often suffer from depression and anxiety.

    We can all easily identify with her descriptions of aspects of physicians work with patients - ward rounds, paperwork, the feelings of guilt, etc.

    Might it all be "because we are human" or because we also lack the same basic knowledge that our patients are also in need of?

    It seems something is missing in medical education, which might make us better doctors and rescue so many from the fall into depression - the answer to
    the question "What am I?"

    If we cannot satisfactorily answer the question "What is a human being?" Can we say we are truly physicians?
    Only in truly understanding the answer to this question can we also find healing for ourselves.
    Mind Body Spirit
    Robert Rollings, M.D. | Memorial Health, Savannah GA
    Your insight and experience are beautifully expressed, and the heart metaphor is simply wonderful. Thank you so much for sharing what you have learned about resilience and restoration, as self compassion in health care providers is an essential lesson for all of us, as the hard work of caring can be debilitating. Gratitude in acknowledging that which has been given to you by both your teachers and your patients is a powerful message which you delivered powerfully.
    Well Written and Insightful Perspective
    Kim Skinner, PT, DPT |
    A beautifully written introspection. Thank you for sharing your struggle and your insight. You have had many wise teachers and in turn, have become one. There are others on a similar journey that will benefit from your guiding light.
    Remember Diastole Therapy
    Cathy Maffry, MBA, BSN, RN-BC | OFMQ
    Sometimes we do not realize we are learning a lesson until it resonates with us later in a "moment", like looking into an open chest at a beating heart. It is a moment of awe that the author brought to life for all of us. As she alludes, it is difficult to leave this work after our shift is over or our patient gone. We remember the looks in the faces of dying people and their families - along with the smiles and excitement when all goes well. The author realized this relatively earlier in her career as she searched for her story. I am glad she took time. I am glad she found her story and glad she shared it with us. Now, I will remember we need diastole therapy to survive and thrive.
    Systole and Diastole, Strength and Openness
    Nathan Strahl, MD, Ph.D. | Private Practice
    What a wonderful metaphor. Brings back memories of MY depression during medical school, my survival through it, the stronger it made me, and the humbling nature of depression when I learned I was not even close to being the brightest and the greatest, but pretty average in fact in a class of brilliant students who have gone on to do great things.

    Through depression, I learned my place in medicine, to not exceed the limits of my abilities, to become excellent at one domain of medicine (psychiatry) and to accept the realities of the medical world I live
    and breath in. As such I have contributed much, have not burned out after 32 years of clinical practice, and will practice medicine until I no longer can.

    Truly, it's a wonderful world.