Machines of Burden

By Richard Osborne – Class of 2014

“Don’t get too close.”

We’ve all heard the proverb of the stoic physician, of the commanding stalwart who treats but seldom feels. The notion that there is a perpetual tension between empathy and efficiency in medicine is as old as it is clichéd. Compassion, we’re told, is the gateway to emotional burnout, and so the doctor’s dalliance with human connection is purely an ephemeral one; he sees in suffering something profound, but by the time he reaches out to touch it, it’s already gone.

Forgive me if I refrain from spiraling on that pity-ditty of doom. Don’t get me wrong; I enjoy half-baked metaphors about emotional distance as much as the next guy, but I think we’re all at a stage now as medical students where we can spot a false dichotomy when we see one. Surely it is possible to care for patients without living vicariously through them.

That being said, there is no denying that long hours and heavy caseloads deleteriously affect physician performance. It can be challenging enough to elicit an entire patient history without also being tasked to appreciate feelings and parse psychological conflict. Down the hallway awaits the next consult, and the one after that.

Thinking back, over a year now, to MF3, I can still remember an experience during a clinical skills session that demonstrates how easy it is lose ourselves in the machinations of the daily grind. One evening, our resident preceptor was teaching us how to take a detailed renal history while we stood around the bed of a patient suffering from chronic kidney disease.  A few beds down on the other side of the room was an elderly woman, writhing in pain and screaming loudly. I looked back at her and she stared at me with wild panic in her gaze: “help me!” As I wandered over, my group called me back.  It turns out she was not in any imminent danger, having been assessed some moments earlier by a resident. I was told that crying on the wards was a common occurrence and “nothing would ever get done” if we attended to every patient who called out for assistance. The resident then called for a nurse while everyone continued to “learn a history” amidst the cries calling out from 3 beds down. Distracted and distressed after 5 minutes of ignoring this woman, I decided to interrupt the resident to remind him that no nurse had come and that there was still a patient in need of assistance.  I’m not entirely sure what disturbed me more about this incident: being asked not to approach the woman or continuing to “learn” as she yelled out, “they won’t help me!” What I do know is that what happened shouldn’t have happened. Everyone has things to do and places to be, but surely, barring a catastrophe, we are sufficiently flexible to turn around and acknowledge a patient asking us for help.

It is not difficult to bridge this singular anecdote to an overarching unease I feel about my medical career. I chose medicine so that I could connect with other human beings and be present with them as they become ill, as they heal, and, in the end, as they die. But in many ways being a doctor is also a job – a tiring job with too much to do and too little time to do it in. I sometimes worry that finite resources beget finite compassion. Will my own exhaustion inoculate me against the cries of patients? Do I really have what it takes to care about every patient every day at every hour?

Within these questions resides an even more primitive angst. Having chosen to dedicate my life to being a doctor, I have necessarily denied myself other opportunities. And while I am sufficiently reconciled to the notion that making fundamental choices requires sacrifice, I can never really escape the desperate, almost haunting voice in my head lamenting, “This is not all that I am.” I can feel my life slipping by. As I get older, time moves more quickly somehow. Experiences become more fleeting, even the deepest of connections more ephemeral. I find myself reaching out for new ideas and new possibilities at the precise moment I have voluntarily been consumed by a singular option. It is a perpetual struggle to find solace in the profundity of my choice because along the horizon of what were once possibilities resides what is now lost – out of reach, intangible.  I need only wander a bit further to hear the calls of my own mortality. After shepherding so many to their ends, it will be my time to die. That’s why, even at this early point in my career, I need to believe that when that moment comes I will be able to look back on my life and not regret the things that I have done. Will I have simply meandered through a career of 18-hour days and 6-day weeks, checking off names as if they were completed job duties? Or will I have actually confronted in my patients’ cries the gravity of my choices and the pull of my responsibilities?

In short, I have invested too much of myself in medicine to resign myself to a career of emotional indifference. I don’t pretend to have an answer to the endless battles with the clock. I wish I could say, having entered clerkship, that the well-being of patients is inexorably my first priority. But I can’t. Some days I’m just tired, pre-occupied, and indifferent. Sometimes I would give anything just to be somewhere else. This does not mean that I have cast away the compassionate physician as a naïve pipe dream, or that it no longer hurts when they cry. For even at my worst I recognize that my wary and my doubt represent a fallibility inherent to being human, not unfortunate incidents of sentience in an otherwise reliable robot.

I am not a machine.

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