Sometimes, medicine isn’t elegant

“The hospital room was as cold as dead skin, the hallway crowded with lost souls and reeking of illness.”
― Raquel Cepeda, “Bird of Paradise: How I Became Latina”

Once upon a time, I met a young lady who wanted to be a doctor. I could see the naked determination and resolve in her eyes. Her older sister, who was a friend, asked her to talk to me about her dream.

I asked her why she wanted to be a doctor. She told me she wanted to help people.

“Great,” I responded.

Then I asked her if she had ever spent time in a hospital before — not as a patient but as someone who got to see what really went on behind the walls. She had not.

She was a junior in college, so I asked her where she went to school. She told me. She was in college in a city with a famous and bustling emergency room. So this is what I told her:

“I am neither going to encourage nor dissuade you from studying medicine. I think you would be best served by seeing for yourself if medicine is a good fit for you.”

I suggested to her to go to the hospital with the famous ER and ask to shadow an ER doctor for at least a week.

I gave her that advice for two reasons. I wanted to see how strong her resolve was and also get her to see medicine at its rawest. I predicted that at the end of the week, she would know if medicine was really for her.

She took my advice. That summer, she did a week of shadowing at that ER. What she witnessed affected her so much so that she took a gap year after her senior year to really think about her decision to be a doctor. When we talked a year or so later, she told me how shocked she was to see the inelegance and misery inherent in hospital medicine. She was so shaken by the experience that she wondered if the profession was right for her.

In her heart, she cursed me for my advice and herself for listening to me. Her family was not happy with me, either.

Towards the end of the gap year, however, she slowly realized that in spite of all that she had witnessed, she wanted to practice medicine.

She felt a certain readiness.

Well, what do you know? She got into med school, finished residency, and a fellowship and has been practicing for over a decade now. She is still very happy with her decision to become a doctor.

I led with this story to introduce the fact that the practice of medicine and surgery is not always elegant and aesthetically pleasing. One sees doctors in their white coats or suits or even scrubs, looking all dapper and self-assured. If you only knew what they did!

Look beneath the surface, and what you see is not always pleasant. There is the trauma, the dying, the mucus, urine, spit, feces, urine, blood, tears, screams, death.

The smell of dead bowel is like nothing you have ever smelt until you have to care for a patient with necrotizing fasciitis! The smell can wake the dead.

The unsightliness of the diabetic foot. The 60-year-old in congestive heart failure drowning in his secretions. The 80-year-old impacted from feces so old it feels like concrete. The homeless drunk puking. The unmistakable smell of the patient in renal failure. The woman with bedbugs crawling all over her. Teeth so dark and rotten they fall off when you touch them. The 25-year-old old riddled with bullets bleeding out. The man who just lost his whole family as when a drunk ran into them having his leg amputated. That stillborn baby.

Yes, the practice of medicine and surgery is not always clean and beautiful. It can be dirty, smelly, bloody, and even violent.

Sure, one can build an elegant and aesthetically-pleasing practice devoid of all those unpleasantries and cater to only the young and beautiful and vain, but those are the exceptions. Those practices, necessary as they may be, do not reflect the miseries of our short existence on this earth. They mirror a wish to leave those ordeals behind, and that in itself is necessary.

However, not all are young, beautiful, and vain. Some are old and really sick. Even young and chronically or even severely ill. These unlucky ones are the people who grace the hospitals with the misery of their suffering — a suffering that is not always stately.

Even as heartbreaking as the physical manifestations of suffering are, the stories that hide behind the lives of patients. It takes a little work sometimes, but one can always get the tales that turn mere patients into humans. Like the gore of blood, feces, and vomit, some of these stories turn your stomach, make you hold your nose, cause you to cry inside, or even marvel at the strength of the human spirit or the power of love.

Yes, the practice of medicine and surgery is not always elegant. It is also a rather possessive and exacting mistress.

From doctors and those who toil with us — the nurses, nurse practitioners, nurse anesthetists, physician assistants, etc. — this practice demands a singular focus. The practice of medicine and surgery does not care if you did not sleep well, or your back hurts, or you haven’t had lunch, or your wife ran off with the yoga instructor or your husband is cheating or you lost money in the stock market, it does not care.

It demands that we see and acknowledge the misery and suffering that is causing the inelegance and fix it. It demands that we look beyond our sensibilities and help that suffering woman whose bodily odor is unlike anything we have ever smelled.

It demands that we tap into the deepest recesses of our souls and dig out all the empathy we can find. Like a sculptor who turns a block of marble into a piece of art, the practice of medicine and surgery demands that we become artists and turn the inelegance of suffering into the elegance of heath.

Nana Dadzie Ghansah is a cardiac anesthesiologist.

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