One of my most impactful experiences during my third year of medical school was spending time with my patients and getting to know them. I went into medicine because I believed in the special relationship between doctor and patient. As I was shadowing in college, I was amazed by how within minutes, a stranger would reveal physical and psychological details about their life they might not even share with their family member or priest. I found these stories moving, not only because I found the courage and grace that patients summoned in the face of serious illness inspiring, but I found a unique connection over shared experiences and shared values. There was hope. There was fear. There was love and there was passion. There was life.
The relationships I made with patients throughout my clinical rotations validated all the hard work I had put into medical school. And yet, I was cognizant too that I could form these relationships with my patients because I was only carrying two to three patients as a third-year student. My attendings also cautioned me that as my responsibilities grew and my patient load increased, I would have less time to nurture the same relationships.
My first priority as a trainee is to develop the clinical competence to take care of patients’ medical conditions. I take that role very seriously. But medicine goes beyond just problem solving and being a “fixer.” There are many jobs out there that allow one to fix problems: carpenter, engineer, mechanic. What stood out the most to me about medicine was how it was the most human of the fixing professions. There is nothing more human to me than life, death, and questions of mortality and suffering and its accompanying emotions. Millenia of artists have sought to capture this in literature, art, opera, and drama. It’s very much so the essence of the human experience.
More so, patients appreciate this human approach as well. Illness is different from disease. The experience of sickness is isolating, frightful, and induces a complete loss of control in the patient. Compassion, assurance, and partnership are antidotes to these primal emotions.
Nevertheless, I wondered if I could still achieve the depth of engagement with patients and experience the full richness of a patient’s story even when I could no longer spend an hour at the bedside with each patient.
I thought of a practice by President Obama while he was in office. He would read the letters of his constituents. He believed that the act of writing engaged the writer to share the fullness of their narrative. He wanted to know exactly how the core issues he was working so hard on truly affected American lives. These stories humbled him and kept him grounded, and helped him feel connected to the American people even as he felt a sense of isolation being in the White House.
I asked the patients I was taking care of if they’d be receptive to writing me a letter about what they wanted their caretakers to know about them. Many of them were. They wanted doctors who would listen to them, to understand them as a person. Writing was an outlet for them to do so. In the many hours that patients spent in the hospital, they would write astoundingly intimate letters.
A patient with multiple sclerosis wondered whether she should blame God, her parents, or herself for her condition … and how she hopes that doctors could recognize that she was once a real person before her condition deteriorated. A patient with a decubitus ulcer shared how she is the caregiver for her 88-year-old mother and an autistic son and how her love for them keeps her motivated and strong to get better. A patient with end-stage breast cancer encouraged me to not be afraid of talking about death with her and that she knows what the eventual outcome will be…though her terminal disease has taught her how to forgive those who had wronged her. Most haunting was a younger female in her 30s with heart failure who feels she still has a lot to give to the world … and yet she has learned to enjoy the small and insignificant things that life can offer.
Reading these letters was deeply moving. I felt I could see my patients in a new light. Their stories made them come to life to me, as a character in a novel would. I acknowledged the secrets they shared with me, and even in the shorter interactions I had with them, I found I could still connect with them by remembering details about their lives. If I knew what was important to my patients, I could motivate my patients and keep them engaged with the care team. Their love for life and for their families could give them solace, comfort, hope, and strength, as much as I could.
As I shared these letters with my residents and attendings, I saw a spark and joy return to their faces. The realities of a life in medicine can at times be an isolating endeavor. We go through training and witness things that most people can never quite understand unless they are in health care and go through it themselves. Furthermore, the relentlessness and the workload pressures may have us going through the motions and becoming myopic in our vision. But I do believe that most of us enter the profession for noble reasons, that we recognize the calling it is to serve our fellow human.
In the words of Marcel Proust, ‘The real voyage of discovery consists not in seeking new landscapes, but in having new eyes.” This work can galvanize and inspire. When we take a step back and can find ways to take in the moment of being with a patient, that is an opportunity to connect with another person on the most human of levels. That is an opportunity to reconnect with one’s intrinsic love for the practice of medicine.
Johnathan Yao is a medical student.
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