Several days ago, I had the opportunity to listen to a lecture by a visiting physician who practices narrative medicine, a medical humanist. She is well-known for bringing a voice to the interactions between doctor and patient, the healing relationship, the unparalleled bond formed between these two individuals. In her talk, she spoke of the “turmoil” that ensues when caring for a patient, caused by the interaction of deep concern for the patient’s well-being, years of medical knowledge and experience, humility in the face of illness, the trust of a patient, fear of choosing the wrong path, and shared amazement at the ability of skin and soul to heal.
I had never heard it described that way before. “Turmoil.” The advice that is generally given, by those in medical school, courses on doctoring, senior colleagues, your peers, is to be sympathetic and removed. Complete dissociation from the red-eyed, pale individual pouring her story into your lap, however, is impossible. The encounters change you, sculpt your responses, awaken you from sleep. A night spent telling a roomful of family members that their sister will not survive til morning, explaining to a woman that her husband, healthy and playing football with his sons just 6 months ago, is now bedridden, are not carried out by an emotionless machine. It is the faces, the pressure of cold hands holding mine, and the hoarse “thank you”s that I remember most. The stern eyes of family who can’t help but blame you for the dissolution of their loved one’s flesh. The raspy breathing of a man lying with eyes closed between 4 steel enclosures in a white hospital bed – it is their faces and the stories of their failing bodies that stay with me. The courage of individuals to say “this is enough, please call my family, I need to say goodbye.”
We travel in directed paths around the hospital, young and inexperienced as interns and residents, with clear immediate purpose but hazy long-term understanding. The nature of hospital work, built of sharply defined short-term goals, intense patient interactions and scuffed Dansko clogs, is both comforting and soul-churning. It is heartening to see a patient breathe again after the fluid filling his lungs is removed, but the feeling of futility can be consuming when a chronic disease, long uncontrolled, visibly erodes a life in a matter of hours or days.
Cases with the hope for recovery, often seen in the deep and lasting relationships between patient and doctor in outpatient care, may actually cause the greatest inner tumult. This tornado of thought and emotion may be seen as the mark of a good doctor – caring so much that patients are always on your mind, running late since you take time to fully listen to each person on your overflowing schedule, giving and caring for your patients as if they were members of your family.
To shape these qualities to act as boons rather than paralyzing burdens, however, is a difficult task, and requires help from more experienced peers and mentors. Our lifelong education should be expanded to include lessons in the humility and humanity required of us to best respect ourselves and our patients. It is this infrastructure of support that separates those who use this inner turmoil for benefit rather than burnout.
Meghana Gadgil is an internal medicine physician who blogs at Life and Sundry Adventures of a Postdoc Wanderer.