When I started my career 15 years ago, I was the prototypical clinical dietitian. I followed all the rules. Diet recommendations were dictated by protocols, precise mathematical calculations and solid scientific research.
As a consultant for several long-term care facilities, my job was to ensure that residents were being offered diets that not only supported their health, but in many cases improved it. Chronic medical conditions often made this challenging, though, since many of those conditions required dietary restrictions.
I remember one resident in particular. She was undergoing dialysis treatment and was also not eating well. After carefully studying her lab values, I constructed what I thought to be the perfect diet. It consisted of a laundry list of foods that she could not eat. If it was high in potassium, forget it. High in phosphorus? No way. I cannot even remember how many restrictions I had listed, but I’m sure as I wrote the list my expression looked much like Ralphie’s as he wrote his letter to Santa…intent! I want an official Red Ryder, carbine action, two-hundred shot range model air rifle (with a compass in the stock)!
I confidently faxed over my my recommendations to the physician, satisfied that I had just executed the most evidence-based recommendation possible. It was perfect! Of course it would be approved. I had thought of everything!
I was crushed when the fax was returned with the words, “What’s left sawdust?” scrawled across the top. (Clearly not approved.)
That physician knew something that I hadn’t quite grasped yet. I realized at that moment, thankfully early on in my career, that good medical care is not about know-it-all providers dictating our behaviors. Good medical care also considers what makes life enjoyable. It understands that what’s right isn’t always perfect, and what’s perfect isn’t always right. It takes into account the things that make us human as well as what science tells us is the best treatment option.
Perfection isn’t real, it’s an illusion. In fact, perfection is nothing more than what each of us feels is perfect for us. It’s defined by us, the beholder.
It’s unlikely that I’ll forget this lesson, since every time I see sawdust I’m reminded.