Care about people as people, not just as hosts of disease

I never thought I would call cancer “cool.”

It was the last day of anatomy lab. Finally, we had dissected through everything: starting with the back, moving through arms and legs, hands and feet, chest cavity with lungs and heart, abdominal cavity with gastrointestinal organs, pelvis, and ending with head and neck.

Looking at our cadaver was disorienting. There were insides where outsides should be. Organs completely removed. The head literally sawed in half. Some of it was hardly recognizable as belonging to a body.

Before my labmates and I bade farewell to the body that had taught us so much, our professor handed us an envelope containing two pieces of information that had been kept from us throughout the journey: our donor’s date of birth, and cause of death. We tore it open eagerly.

“Cool!” I exclaimed, as one of my labmates simultaneously said, “We got it! That’s awesome!”

Our first response to the news of prostate cancer was gratification.

Stepping into pathologists’ shoes, we had made our guess several weeks earlier. During the pelvis dissection, we sliced through skin and fat and located the prostate gland. It is supposed to be the size of a walnut. The one we found was the size of a tennis ball. We reassembled skin and noticed tiny blue dots tattooed on our donor’s abdomen, indicating he had undergone radiation therapy. This must have been it; this was what got him, we had decided.

“I mean … um, cancer isn’t awesome,” my labmate clarified, embarrassed.

I knew exactly how he felt. As future doctors, we have to be especially careful as to what emotions we let on. Trust is eroding in the doctor-patient relationship. There exists a stereotype of a cold, distant doctor, who objectifies rather than empathizes, seeing patients as problems to be puzzled through instead of thinking, feeling human beings. It isn’t the fairest characterization. Yet its persistence means that we who are entering the profession must take extra efforts to combat it.

No one wants a doctor who thinks cancer is cool.

In medical school, I sometimes feel inundated with conflicting messages. On one hand, we are encouraged to think like scientists. To be curious. To ask questions. To form innovative hypotheses, and to test them. To find the beauty in discovery. Many times over the course of anatomy, our professor came over to a cleanly dissected region on our cadaver and called it “beautiful.”

And it was beautiful. As the weeks went by, I found myself increasingly awed by the elegance of the human body. I held a human brain, weighing a mere three or so pounds, and thought about all the things it can comprehend and create. There is so much happening beneath our conscious awareness, you’d think the human machinery would malfunction more often – or that we’d at least notice some of its efforts. The smooth inner workings of the body provide us the luxury to engage in everything else that makes us human.

And that’s the other message medical school sends. Be a humanist. Cultivate and display empathy. Care about people as people, not just as hosts of disease.

When to display each quality is a trickier matter. I wonder what the appropriate reaction would have been during that last day of anatomy lab. Should we have opened the envelope with solemnity? Summoned fitting empathetic remarks? Taken a moment of silence?

Our professor called our cadaver our “first patient,” implying we occupied a caregiver position. But was he really a patient? Should we have treated the news of his illness with the same compassion we would have expressed if learning a patient’s diagnosis? Is it ever appropriate to feel a sense of wonderment over illness?

We traverse the boundary between investigator and carer so frequently, it is hard to remember where we are supposed to be at any given moment.

I once interviewed a patient with advanced cancer. Tears came to his eyes as he told me about how he had to leave his job, couldn’t run around with his grandchildren, couldn’t do the things he loved, not like he used to, nope, not anymore. A single diagnosis had inflicted such profound devastation.

In an emotionally detached cadaver, cancer was cool. In a person, it was anything but.

As my training continues, I imagine that I will uncover more beauty in medicine. I imagine I will feel gratification when I diagnose something correctly, and that I will encounter phenomena that will make me think, “Wow. That’s so cool.”

I want to stay fascinated. I want to care.

It’s a clash of emotions I wonder if I can ever fully reconcile.

Ilana Yurkiewicz is a medical student who blogs at Unofficial Prognosis.

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