Physicians can choose to nurture their human side

A keynote address to Gold Humanism Honor Society Induction Ceremony, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

As an intern, I was assigned to 9 weeks over the year on the bone marrow transplant inpatient unit.  It was medically fascinating but emotionally draining and anxiety provoking.  I began to get nauseated going to work because I was having such a hard time with the rotation.  As I sank deeper into anxiety and self-doubt as patient after patient died or had terrible complications, I met a patient who forever changed my attitude towards humanism in medicine, and I’d like to tell you our story.

Her name was Carol.

She was a 55 year old with metastatic ovarian cancer with a sparkle in her eyes despite being on clinical trial for BMT. I met her several weeks into her “hail mary” experimental treatment and things were not going well.  But, Carol was my patient, so I put my head down and plugged away.  I was increasingly arriving to work anxious and dreading what each day would bring.  I had a hard time girding myself to see her each day.

I felt like all I was explaining was why the things we were doing were making her sicker and not working for her cancer.  I had overwhelming guilt that we were not helping her as she slowly died in front of us.  She’d had virtually every complication you could imagine over a stay approaching 30 days.  And she was lovely — she’d get frustrated but always look towards tomorrow as a new day.  One day, I was disinhibited by fatigue and sadness, and I burst out, “I feel like I all do is tell you how we’ve messed up or caused complications, and we never talk about anything good.”  She said she felt the same way, so each day after that, after the horrible updates or the good days which were when nothing bad happened, we looked for nonmedical things to talk about.  She was a patient who had been hospitalized for most of the last year, and I was an intern in the era before duty hours, so that was harder than it sounded.

But I found out she was an avid gardener, and I was trying to plan a herb garden for my postage stamp apartment deck.  So, she started teaching me about growing plants in pots.  What had worked for her, what might work for me, what kind of pots, what kind of plants.  It seemed like an inconsequential thing, but I stopped dreading going to her room as much.  She missed her garden very much, but planning mine gave her a bit of hope.

My last day on service, I went in for our usual afternoon conversation, and she handed me a gift.

Me.  A gift.  An intern who was watching her die as we did terrible things to her body.  And she had arranged to give me a gift.

It was a book on container gardening.  I still have it on my desk.  Inside was a note that still makes me teary when I read it, but I read it from time to time anyway.  Here is what it said:

Dear Gretchen,

You are my guardian angel!  I would have never made it this far without your kindness and patience and taking the time to answer all my questions.  You are a wonderful doctor and a very special human being.  I wish you the very best in all your future endeavors.  Happy Gardening!

Fondly, Carol

I was floored.  Jaw on the floor amazed.  And humbled.  While I didn’t think I was taking very good care of her, she thought I had.  Then, she had tried to take care of me.  And so I cried and laughed and eventually hugged her goodbye, C. diff be damned.  And she died the next week.  And I planted my herb garden, as I still do every spring, and to this day derive such simple satisfaction from it.

Here’s what she taught me.

Patients are humans.  This sounds inane to say out loud.  But, how many times have you done a double take when you see your patient in street clothes instead of a hospital gown?  Or bumped into them in a store?  Or walked in one morning to a 93 year old who has insisted on putting on her full makeup prior to her colonoscopy? Or seen a photograph of your ventilated patient full of life on a ski slope?  That double take is because you forgot they were human.

You have a choice.  It is hard to maintain humanism sometimes.  When you are at your busiest, that is when compassion, empathy, and humanism are tempting to push to the side.  They can interfere with efficiency, they take energy to do well, and they come with a risk of feeling pain and suffering.  Everyone tells you to do it for the patient, and that is important, as Carol alluded to.

But, my motivation is actually selfish. The effort pays dividends that are good for my soul.  It takes deliberate practice when burnout sets in to focus on that. It’s easy to focus on the “hard skills” of medicine and judge performance solely on clinical indicators.  When I feel myself heading in that direction (depersonalization and emotional exhaustion), I take a deep breath and pull up a chair to the bedside.  Just changing the lens to one where you can see the person across from you and the human within you can be restorative.  And it changes your personal narrative — the story of you as a developing physician.  If you define yourself that way, it is easier to prioritize the humanistic aspect of your professional identity.  With Carol’s help, I understood that I had a choice.  I can choose to nurture that side of me.  And while it is an ongoing learning and refining process, I choose humanism whenever I can.  I am only human myself after all.

Gretchen Diemer is an internal medicine physician. 

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