The inhumanity of medical residency programs


My mother-in-law died last week.

She’d single-handedly raised two sons on a social worker’s salary after the love of her life, her husband, died with metastatic melanoma. After her sons left home, she stayed alone on the farm in the middle of nowhere. When she turned 73 and felt the swell of grandmotherly love in her chest, she moved to the city to help raise her first set of grandkids, now isolated by a sticky divorce at age 3 and 5.

Her second set of grandkids were born into career parents. She was there to help again, babysitting at a moment’s notice. And when she died, the eldest grandson from her son’s third marriage had just received his learner’s permit to drive. The youngest had just celebrated his eleventh birthday.

She lay in a black box, stunningly beautiful in death. They’d closed her eyes and combed her hair. Nothing more needed to be done.

It was a simple affair. She was a practical woman, and certainly didn’t want any unnecessary expense, having grown up during the depression. In fact, she’d been saving articles. “7 Ways to Save Costs On a Funeral,” read the newspaper clipping on her desk, dated the week before she died.

We gathered around her body, holding each other tightly, and wept. For the next 3 days after that, we worked to clean out her apartment. As we sifted through her things, we’d come across a gem or two telling us of a life that none of us knew.

“Six sets of negligée’s!” exclaimed her daughter-in-law. “And a … a vibrator from the late sixties?!”

Those 3 days were cathartic. Together, we laughed. Together, we wept. And together, we consoled each other and learned how to heal.
I was in charge of washing her clothes from the laundry hamper the week before she went to the hospital. I folded them — a green cotton top and grey slacks — holding them close to my chest for the longest moment. Then, I set them carefully on top of the pile of stuff headed for donation.

I remember the times when we talked about how she’d grown up dirt poor on a farm.

“Daddy died at home,” she’d said. “We did our grieving. And then we pulled the sheet up over him. Death was very much a part of life and family.”

Her eldest grandson from the first marriage, a young man of twenty-seven and terribly brilliant, had just graduated medical school in June of this year. He was very fond of her as she’d been the go to person during the divorce. For summer vacation, she’d load him and his older sister up in the van, and drive across Louisiana and Texas to Arizona where her eldest son, their uncle, was attending graduate school.

By high school, he wasn’t sure what he’d do with his life. Studying history was his passion. But then, he met his future wife.

“I’m going to be a doctor,” she said. He switched majors immediately and signed up for medical school.

His grandma was very proud the day he graduated. She was very proud to witness every one of his birthdays, never missing a card. She was proud to keep the awkward little crafts he’d brought home from school, just as she had with her own two sons. She never failed to send to every one of us, on the exact dates of our birthdays, anniversaries and holidays, a reminder that we were the most special people on earth to her.

Her doctor grandson received the sudden news of her death from his father. The summer was over and he’d just been matched to a residency program in the same town where they’d all grown up. In fact, he was only a week or two into his first rotation.

When he requested leave to attend her service, he was denied.

“Not unless you can get someone to cover your shifts,” was the answer.

No one was available to cover.

As the rest of us beheld his beloved “Gran” in death, drawing much-needed support from each other, her first grandson, a newly minted doctor of medicine — the very type whose job it is to become the most compassionate human being of all professions possible — was working as a very junior resident. By all respects he was inconsequential in the massive hierarchy of the hospital system. It wasn’t as if he was a world famous neurosurgeon about to separate conjoined twins, and whose clinical service was critical. He was just a boy whose most loved grandmother had suddenly died.

He was just a boy, stuck inside the most inhumane of humane professions, trying to take care of humanity in the most duplicitous way possible. He was just a boy at the mercy of some callous attending physician who didn’t have the conscience to allow a moment of dignity for him to grieve with the rest of his family. He was just a boy who would remember this badge of indoctrination for the rest of his life.

In a few weeks, her doctor grandson will get a box in the mail. Inside it will be all the trinkets he ever gave to his Gran to guard safe over the years, as she did without fail. Inside it will be all the tears and laughter, the hugs and kisses, the frustration and the joy of a lifetime — his lifetime with her.

But most importantly, inside it will also be the memory of his chosen profession, training him to become the greatest doctor on earth, while taking away his own dignity and compassion, inside of the first few days of a residency program.

It’s not death that’s the most painful to us, but rather the pain of not being there when we most need to be there. This is what hurts for a lifetime.

Natasha N. Deonarain is CEO and founder, Conscious Health Solutions.  She is the author of The 7 Principles of Health and can be reached on Twitter @HealthMovement.

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