How to steel myself against this profession I have chosen

An elderly man startles awake after a man in a white coat touches his shoulder.  He looks around and sees three other white-coated people standing around his bed.

“Sir? Good afternoon, sir. How are you?” says the man who touched the patient’s shoulder.

“Oh, I’m fine.”  He’s perfectly calm.

“I know this is a silly question,” continues the man, “but do you know where you are right now?”

“Of course, of course. I’m at home.”

The slightest pause. “Sir, you’re in the hospital.” The man in the white coat names the hospital.

“Oh yes, the hospital,”the patient agrees. It’s as though being at home were just a slip of the tongue and not the mind.

“Do you know why you’re in the hospital?” the standing man presses.

“I’m here … I’m here because you’re giving me circulation to my leg.”

“Actually, you just had an amputation of your leg.”

The patient’s expression freezes, but like many people with dementia, he covers whatever internal processes he has.

“Your leg was just amputated.”

This is not the first time the patient has woken up after his surgery.  According to the nurses, he had been tearful all day trying to cope with the loss of his leg.

“Can you repeat that after me?  Your leg is amputated.”

The patient repeats it, in a tone that I’ve used to talk about the weather.

“Okay?  Your leg is gone.”

And just for good measure he lifts up the blanket and shows the patient the nothing that is there:

“Your leg is gone.”

The doctor turns and leaves.  The other people in the white coats who are not in the patient’s home not giving circulation to his leg follow his lead.  The whole encounter takes no more than 120 seconds.

The third year medical student in the white coat looks back at the man’s frozen expression. With this glance, she has already fallen out of step with the team.

A social worker enters as we leave, pulling the curtain around the patient’s bed.

A curtain around a man who doesn’t wake up from nightmares but into them.

Someone please tell me.

Someone please tell me how to make a box in my mind and put patients into it and seal it and make the patients stay in there until I say they can come out and–actually, on second thought–maybe I’ll just never let them out.

Because I am having nightmares too. But at least I am waking up in my home with both my legs still there.

Someone please tell me how to steel myself against this profession I have chosen.

Shara Yurkiewicz is a medical student who blogs at This May Hurt a Bit.

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  • Jean Bean

    I have been in geriatric nursing for 27 years. Most of my days are filled with older folks in the nursing home, telling me jokes, stories and just ” hanging around the nurses station” waiting for some action. I give out more than medicine, I give them someone to talk to. I consider these patients family, we all do. I consider it a great privilige that they feel comfortable enough to trust me with how they feel, or things that are bothering them. I always try to improve and make them as happy as possible in their situations. And it breaks my heart when a patient is so sad to realize they will never go home and now “have to live in a nursing home”. Yesterday, I tried to comfort a wonderful patient who was upset because she will not be going home and that “my family lied to me”. She just cried, I tryed to tell her that they all loved her, but couldn’t decide who’s house she should go to, but that they all visited her here. She turned to me and said “Why can’t I decide”. And she’s right. I also have dementia patients that think they are in their 30′s, tell me the funniest stories and have no idea where they are or don’t care and they are the happiest. Maybe reality isn’t the best thing in certain situations.

  • http://twitter.com/Meryl333 Meryl at Beanstalk

    “Steeling yourself” may not be the answer. Mindful awareness of your emotions and allowing them to come in the door may be the most beautiful way to be resilient and present for yourself and your patients. Wounded healers are the best healers. Being a medical doctor is tough. Requiring only faith in what can be proven inside a small arena of knowledge is sad. So much is missed.

  • http://www.ausmed.us/curriculum.php International Medical Schools

    Hmmmmm. It’s tough to steal yourself with this profession,if you’re going to stay in this profession. Please don’t think to leave this profession.Just think how to stay alive the patience mind in that scenario,ofcourse this is tough but there should be a way we need to find out………..

  • http://www.facebook.com/victor.panagiotakopoulos Victor Panagiotakopoulos

    I am disappointed with the way you presented your dream, opinion, article whatever you call it. Maybe you should seek some professional psychiatric help.

  • Kathleen Ogle

    Please don’t give up. The profession you are feeling you must steel yourself against is NOT your profession, it is NOT the only way medicine (or surgery) is practiced. What you so eloquently describe is the worst of medicine, the burned out hulk of medicine’s ravaged soul, the result of a hidden curriculum that all too many doctors (and nurses) get hazed into all too quickly. But caring and compassion are out there — you have them, quite clearly. Hold on to that. Find people who work in medicine who you admire, are like you, who still believe they came to medicine for the same reasons you did. Find colleagues, friends, companions who can band together with you and support you to hang on to your soul while you go through med school and training. And learn from the pathetic burned out probably scared spitless white coats who don’t have a clue about how to relate to the elderly man with dementia who has lost his leg. Learn how NOT to behave or talk. Feel compassion for those folks in white coats who are way over their emotional and relational heads, and try very very hard not to become them. Because you don’t have to, and there are many many others out there with you who have also chosen not to follow their lead.

    Your post completely touched my heart. I was a third year medical student in 1981, being hazed on a surgical (or a medical) rotation. I felt the same way: “WTF: there are people in med school and residency and attendings and in practice who appear to be motivated solely by money, fame, greed, the desire for power, and not for the ideals of compassion and the desire to care for patients? why didn’t anyone warn me about this culture? How do I survive this?” I only survived because I found my people — in my profession and outside it — and held on tight to them. They supported me and I supported them. I debriefed every day with them. I told them my stories and listened to theirs, I cried and raged and rejoiced and journaled constantly. We all swore that if any of us ever detected one of us “becoming like them” we would be honest and confront it. And we didn’t become “them” — we became incredibly good and compassionate doctors.

    Find your people. (Finding them online is perfectly fine, by the way.) Don’t give up. Please. And take care of yourself, because your self is all you have to bring to this really hard, really rewarding profession.

  • JoAnn Glenn

    Shara, how sad that they have no idea how they looked (momentarily) to the patient but will be forever seared into your memory. But that is not a bad thing. No one (with or without dementia) should be subjected to a 2 minute visit where you are reminded you have lost your leg and then left alone. These folks may have good clinical skills, but clearly are in need of a heart. Your gut told you this was not a compassionate way to treat that poor man. Listen to that voice, find people like you — while you can’t carry all your patients around in your head with you all the time, you CAN choose to be kind, caring, respectful and compassionate to all of them in the moment. The simple fact that this interaction bothered you tells me you are actually in the right field. Find others like you to share with, support each other and help make a difference for all of your patients.

  • drjoekosterich

    It is about managing emotions and doing what needs to be done. Amputation is awful. Perhaps not amputating would have been worse. As a doctor you need to be aware of your emotions but not give into them.