In my very first week as a home hospice physician, my mentor, a veteran home hospice doctor told me, “Start a feel-good file. It’s important.” I nodded in agreement, mentally documenting new EHR passwords and the location of the bathroom.

I think about the words “feel-good file” often. Honestly, I once found it to be a pompous thought; if I was hearing her correctly, my instruction was to gather kind words about myself for my own good. I wasn’t sure how I could be more important than those I survive, or the family that I am apart of. Eventually though, cards and small gifts started floating around my computer bag and my home, leading me to stuff these mementos in a drawer in my bedside table. There I had it, my makeshift “feel-good file”. Good for me. I followed directions.

Good for me indeed. These words were all either sent to me or given to me by patients and their families, thanking me for my services as their hospice doctor. What a special thing. I found myself wondering if any of my friends or family had a “feel-good file”. It wasn’t likely. As professionals in hospice and palliative medicine, we are so very lucky.

It used to be that when I received a card or gift, I’d show my husband what was written about me and beam. In my eyes, those words were written by people in the worst time of their lives. What an honor that they would take the time to write me about their experience when there were certainly more pressing demands on their time. In some ways, sharing these cards was a good way to depict the intensity of my job with my non-medical husband. As I had come to discover, however, these words of warmth, appreciation, and gratitude weren’t always accepted with pride.

I very rarely have to work. Most days at my job as a hospice home-care physician are spent enjoying time with patients and families; sort of like days with old friends, sharing stories, experiences, and prayers (those on-call weekends, on the other hand…). I don’t consider it work. It’s an honor. My husband, however, has a tense job working in the stock market, with deadlines, stressful daily human interactions, and a several hour daily commute. These cards and kind words represent recognition by community members, all for doing my job. I suspect that every card, gift, and drawing that I received reminded him of a fulfillment that he didn’t have in his career.

When I sensed his discontent, I stopped showing him my cards. But I keep them close to me in my makeshift feel-good file, which has become more important to me than my mentor knows.

Let’s face it: while our job is beautiful, immensely gratifying, and glorious, our job is also taxing, nerve-racking, and sad. We meet new people all of the time, get to know them, get to love them (or like them in the case of some COPDers), and we lose them. We go to funerals, memorial services, and services of remembrance. I often struggle with wanting to keep contact with families after their love ones’ death, but am cautioned by many to keep some distance. Such close, intense relationships built in a short amount of time, only to have them dissolve in an instant. It doesn’t quite seem fair to any of us. My “feel-good file” reminds me of journeys I have walked with patients and families, of the weather on the day I first met them, where I was when I heard of their death, and first impressions that may or may not proved true. Review of the “feel-good file” reminds me of snap decisions that I made in the time of crisis, and the joys of an intractable symptom, managed. It reminds me of where I started as an attending and how I’ve grown. It reminds me of how lucky I am to be able to do this job and meet wonderful families in my community each day. Looking ahead, I think the “feel-good file” will help preserve myself for use by others by attenuating burnout. It will stand as a constant reminder that I’m doing good for people, and that this job, like the stock market, is full of both risk and reward.

Yet, I haven’t been able to shake the bit of guilt I feel for having a drawer full of nice things that people have written about me. I have often thought that I feel too good when I’m complimented by co-workers, patients, or their family. Additionally, I have heard co-workers comment on compliments that they have received. Are we a field that thrives on positive feedback? Or do we just need it to do what we do?

Of course, an unintended effect of the “feel-good file” is the constant worry about those whom I felt connected with but never heard from again after a loss. I know I should not expect any feedback on my position in their life, but I often wonder if I did something wrong. Did they view my services as detrimental in any way? I would argue that a drawer full of only positive feedback is dangerous without some balance. After all, there isn’t much to learn from positive feedback.

I should have asked my mentor why a “feel- good file” is so important. I suspect she would say something to the effect of, “Because life is hard” or “It’s good to be appreciated.” Ours is a difficult job, undoubtedly. Ours is a job filled with perpetual loss where we are giving our inner-most self to strangers. Our rewards, however, are plentiful, and sometimes they begin with “Dear Dr. Calkins…”

Bethany Calkins, MD