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Stories influence how I practice medicine. Here’s how.

Red Hoffman, MD, ND
Physician
May 7, 2016
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My father was killed by an Islamic fundamentalist in Cairo, Egypt when he was just 47 years old.  It was October 1993, exactly eight months following the first World Trade Center bombing.  Terrorism was still a new word — and a new concept — to many Americans, and so my father’s death was featured prominently on the evening news and in the New York Times.

For over 22 years, this has been my story.

I was 19 years old at the time, living 1,500 miles away from my family.  I had two roommates and a close group of friends, the majority of whom were as emotionally immature as myself.  What does a fellow teenager say when their friend’s father is shot in the head by a madman screaming “Allahu Akbar?”  Nobody knew.  I didn’t know.  And so my grief was compounded by an acute sense of loneliness and shame; shame for having such a tragic story to share, shame for the overwhelming desire to share that story and shame for making others so uncomfortable in the process.

I am 42 now, finishing up my chief year as a general surgery resident, planning for a career in surgical palliative care.  While the shame associated with my story has faded with time and the need to tell my story has lessened with years, the desire to share in the story-telling process is stronger than ever.

“Tell me your dad’s story.  What does he love?”

As a second year resident in the surgical ICU, I sat at the bedside of a 55-year old man who had arrived at our trauma center with a devastating brain injury.  He was surrounded by his elderly parents and his four adult daughters, one due to give birth in the next several days.  His wife was admitted down the hall with several broken bones.

“He loves us, his wife, his friends, his bike.  He loves that bike!”

His parents shared stories of his wild youth; his daughters recounted tales of “the best grandpa ever.”  The next day, after a declaration of brain death and a decision to pursue organ donation, I helped to wheel him down to the operating room.   Several hours later, I sat with his wife and shared with her how well her husband had done, what a gift he had given to the world.  We spoke for almost an hour about how they had met, the trips they’d taken, how much she’d miss him.  When she was discharged a few days later, she invited me to her husband’s memorial service.  When the morning arrived, I was post call, dehydrated, cranky and exhausted.  But I went and spent two hours laughing with his family while I held his new grandchild on my lap.  And now this memory is one of my favorite stories from residency!

“Tell me your story.  How have you been?”

As a third year resident on the general surgery service, I sat on the bed of a 49-year-old man, our hands clasped together.  I had met him approximately one year earlier when he was diagnosed with perforated colon cancer.  I had operated on him and then cared for him postoperatively in the hospital and in the clinic.  Now he was back in the emergency department.  His insurance had been canceled six months earlier, and so he had lost the opportunity to complete the majority of his adjuvant treatment.  After three months of persistent weight loss, his son had driven him to the hospital where scans confirmed metastatic disease to the liver and lungs.  Unemployed and uninsured, his options were limited.

“Honestly,” he shared, “I’m exhausted.  And I’m worried about my kids.  They’re just getting started in life, and I hate to leave them.”

Drawing upon my own story, I was able to assure him: “A father’s love truly never dies.   Your children will always have you.”

Such a simple request: Tell me your story.  As a fourth year medical student, I rotated on the palliative care service, by far my most memorable month of medical school.  Besides encouraging some of my innate skills, the team taught me how to walk into a room full of sadness and fear and to engage with a patient and her family simply by asking, “Tell me about your loved one.”  While for me, over time, this has morphed into “tell me your story,” the sentiment remains the same; my ears are open, my heart is open, please share with me if you are so inclined.

And what of my story?  Where do the boundaries lie between the personal and the professional, especially when discussing matters of the heart?  I have self-disclosed a few times over the past decade and, honestly, it has never felt as good as I had hoped.   There’s something to be said for leaving one’s “stuff” at the patient’s door.

However, my story — and my father’s story — continue to inform how I practice medicine on a daily basis.  I sit on the bed, place hands on my patient, lean in and hold space and time for the stories to unfold.  Sharing these stories help patients, and their families, to establish legacies.  Listening to these stories help providers to more accurately assist in establishing goals of care.  And celebrating these stories help me to honor my father’s memory and to attempt to mitigate the isolation and shame that often accompanies a devastating loss.

Red Hoffman is a surgery resident.

Image credit: Shutterstock.com

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Stories influence how I practice medicine. Here’s how.
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