“Tell me something you love.”
I love warm chocolate chip cookies — straight out of the oven.
“Thank you. Tell me something you love.”
I love to read, to write, to dance. I don’t know yet if I love medicine.
We were gathered in a ballroom, a group of doctors and dancers, to explore the art of medicine through movement. I sat cross-legged, looking into the eyes of a person I did not know, struggling to remember what to say after “I love …” It had become all too easy to think about the things that I did not love. Only recently did I first think to myself that I hated the person medicine had made me become. So with each answer, I tried to reorient my brain, to move away from what I did not love and towards a love of feeling, of experiencing, of existing.
I had no way of anticipating the demands of medical education. Although I found caring for patients to be infinitely gratifying, I couldn’t overlook my fear that what it took to become a doctor would preclude me from becoming the physician I wanted to be.
It started with the realization that medical education is based on a premise of performance, or what sometimes felt like deceit to me. I began to understand the importance of feigning confidence that I lacked in new skills, for the sake of gaining procedural experience.
“A hospital is not a hotel,” I was told by those senior to me. Although I didn’t think I would ever get used to waking people up in the wee hours of the morning, I adapted. That I didn’t think to question the value of this practice until months later stunned me.
On rounds, we talked about patients outside of their rooms, often saying things we would never dare say inside. A large group of us strangers would gather around a patient naked beneath a thin veil of gown and look down at them as they lay in bed, saying things that we knew they did not fully understand and that we did not fully intend for them to understand.
What terrified me about all of this was that so many aspects of medicine which at first seemed unsettling quickly became normal. My disillusionment with medicine was simultaneous with my acceptance of it; this is what disgusted me most.
While I previously couldn’t imagine doing anything else with my life other than being a doctor, I knew this was no longer true. I’ve fantasized about being a freelance writer and wondered whether an English PhD would have better satisfied my intellectual curiosities. Or, perhaps, a different role in health care, as a social worker or psychologist, would have enabled me to pay attention to the psychosocial aspects of health about which I care deeply, the ones that always seem of peripheral concern to physicians.
It was surprising to me that the thought of medicine as a mistake even crossed my mind. But this thought helped me notice the ways in which medicine had changed me. In fact, it was liberating — to realize that I don’t have to let myself be changed in these ways.
There are moments in medicine that have made me pause. When I watch physicians crouch down on their knees at bedsides — to truly look their patients in the eye. Or when a handshake requires not merely one but both hands to entirely encase that of a patient’s. When a resident spends his Friday evening playing the piano in the hospital lobby for a dying man and his wife. What I have witnessed in these beautiful moments is sincerity: doctors and patients alike can be vulnerable and authentic with one another. These doctors, acting in these ways, encourage me to find a way to practice medicine as I am.
These beautiful moments stood in stark contrast to the other message conveyed by many doctors. Emotional distance, I was told, was paramount for personal well-being, for self-preservation and self-care, for survival. A physician once shared how he becomes “an empathetic machine” when he walks into patient rooms, how emotionally connecting with his patients is a performance that he can simply turn on and turn off as needed.
That’s not the kind of person that I am. For me, it is not enough to go through the motions. The best way I know to cope with the emotional challenges of clinical medicine is by allowing myself to get close to my patients, to feel alongside them. When all else seems hopeless, supporting my patients in the simplest of ways has proven to be more healing than anything I have offered through modern medicine. A warm blanket, a refreshing glass of water, soft tissues. A gentle presence, an attentive ear, understanding eyes. I give myself fully to my patients, and it makes me feel as though I have something meaningful to offer.
When I offered to walk with my patient one day, she looked up at me and asked, “Can you do that?” “Yes,” I insisted to her and to myself. “Yes, I can.” We walked, she with her walker and me beside her, pulling her IV pole down the confined hallways of the oncology floor as we talked about springtime and her garden of peonies back home.
I once brought red-hot fireball candies to a patient eager to go home, a gentle incentive for him to be patient with our team as we treated his illness. His reputation of leaving against medical advice preceded him and, to be honest, he scared me at first. But I sat down with him while he ate his lunch one day. “That looks good,” I said, gesturing to his fruity drink. I was touched when this tough man generously made an orange-cranberry juice concoction — just like the one he was sipping — to share with me.
Then there was the thank you card with handwritten gratitude that I received a month after I had cared for a patient, which took me by surprise. This patient’s kind gesture assured me that, somehow, I had done right by him. I had moved him just as he had moved me.
I will never forget these moments. But there are times when they become difficult to remember, when I find myself getting caught up in the less-than-beautiful things that happen in medicine, the things that I do not love, the things that make me not love who I am. I want to practice the kind of medicine that I believe in, the kind that motivates me, energizes me and fulfills me. My kind of medicine is not a performance; rather it revolves around my patients as they are, with me as myself. There are aspects of who I am and what I cherish that I refuse to compromise for the sake of medicine. I know now that I do not have to make such a sacrifice.
I want to learn how to love medicine, and, I suspect, I will always be learning.
Trisha K. Paul is a pediatric resident and is a contributor to iatrogenesis: Essays on Becoming a Physician.
Image credit: Shutterstock.com