“We pass through the present with our eyes blindfolded … Only later when the cloth is untied can we glance at the past and find out what we have experienced and what meaning it has.”
– Milan Kundera
Two days ago, during a clinical skills session on lymph node examination, my classmates insisted that I get what appeared to be an enlarged lymph node in my neck checked by the physician teaching us. As medical students, we tend to be eager to apply clinically what we are learning in lectures — even if it meant applying it on ourselves. To my surprise, this lump was not a lymph node after all. It was a thyroid nodule which appeared to scare my doctor who insisted on me getting it checked first thing in the morning. Although the doctor tried to comfort me that most probably this lump is not cancerous, his body language depicted his fear and suspicion.
Cancer was never an option for me. We take tons of lectures of various neoplasms in medical school, ranging from benign to malignant. We even touch lumps in our own gloved hands in pathology labs. Yet cancer was never an option for me. I can diagnose cancer, but I never thought it will ever affect me. It turns out no one feels it coming until it actually comes. It just knocks on your door when you least expect it. Is this really how our patients feel? I did not fully understand the magnitude of Sir William Osler’s famous saying, “Treat the patient not the disease” — until now.
Although my lab tests are not out yet, and I still did not do my ultrasound, the feeling of insecurity and suspicion is haunting me. I started contemplating the “what if’s” of the situation. What if it was really a thyroid tumor? What is my prognosis? What does that even mean to me now that I am sitting on the opposite side of the table? I am afraid — afraid even to do surgery and have a scar leftover to remind me of what was going on. I was afraid that my life would change. I was afraid that because I still have a lot more to achieve … but will I ever achieve them?
The feeling that you are a doctor and a patient is debilitating. We learn about the symptoms along with the signs of disease simply because we know certain things are not measured objectively and only the patient himself can feel them. The patient feels fatigue and pain, but can we measure that? We can approach a patient by asking him to describe his pain and fatigue on a scale from 1 to 10. But can he/she decide on a number? Or can we visualize what 8 out of 10 feels? As doctors, it is crucial for us to treat the illness and not just the disease. Compassion and empathy are, to me, the most important skill we will develop throughout our years.
Although my experience will most probably be a passing one, what about those patients whose lab results came out as malignant stage IV? Even when we tell a patient he has thyroid cancer with a relatively good prognosis, thyroidectomy has to be done, and he has to remain on thyroid hormone replacement medications for the rest of his life, do we think of the implications of what we are saying on our patients? Sometimes we do, but sometimes we don’t.
I now understand how overwhelmed, angry, worried and afraid the victim of this unnamable disease feels. I now know why some patients go into denial while others go into encouraging those traveling the same path that the future will be better, even after tens of chemotherapy sessions and even when the light at the end of the tunnel looks dim from where they are standing now. My experience even made me question how to approach a patient, family member or friend who is in doubt or has been diagnosed. It made me want to live the present with all its ups and downs. Not to dwell on the past, and not to contemplate the future that might be twisted in a second. You never know what is coming.
I understood that we never understand other’s pain except when it becomes our own. And when it becomes our own, we will learn all about it. We will kindle it, “wax and wane” it, then learn how to extinguish it, just like candlelight. The more the light grows, the more it eats up the candle. The more the pain grows, the more it eats up the human.
I have not yet started clinical rotations, but I now know I am ready to dwell on the spectrum of emotions along the way and to lay my longing eyes on what I’ve been studying about in real life. I can certainly tell you that this feeling is a double-edged sword. As always, I will be fascinated by each case as if it were my own for some reason. But this attachment still leaves me wondering in the end.
As a physician-to-be, I used to think the diseases I learn about will never affect me, but who knows? I now know how to do right by my patient. In the 2012 commencement speech to the Harvard Medical School graduating class, Donald Berwick depicted the following metaphor:
“There is a way to get our bearings. When you’re in a fog, get a compass. I have one — and you do too. We got our compass the day we decided to be healers. Our compass is a question, and it will point us true north: How will it help the patient?”
I learned to remove my blindfold as to how I use my patient as my compass. North is not the correct diagnosis. North is asking the correct questions, not missing any information in the history, and most importantly, north is the circle of hope and pessimism my patient is in.
Christina Abi Faraj is a medical student.
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