RPP Adaptation – MF1

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By Anonymous. Photograph by Paul Morris (@oldskool2016).

During the year that I worked, I had a few days off here and there due to the structure of my contract. I volunteered at a hospital, with the knowledge that I won’t be able to spend as much unfettered time with patients as a medical student, and eventually, as a physician. There is one patient who will stay with me for a long time to come. She was not the most pleasant patient to be with, and yet was the neediest of them all. I probably spent the most time with her out of all the other patients on the ward, and yet I only have one good memory of Josie. But I have many bad ones. On multiple occasions, she would cry and tell me that she did not want to die on the ward. She would alternatively be sullen and wish for death under her breath. I do not really have the words to describe what it was like to be in those moments. Even now, I have trouble thinking about it – a lump forms in my throat which refuses to go away until I shift my thoughts elsewhere. But in those moments, I would always attempt to comfort her, copying her mother in telling her that everything will be alright, that everything will work out fine, and that she will be able to leave the ward soon. But that changed the day that I took a look at the information that was provided to volunteers by the staff. I was told by the volunteer coordinator to read her file, given the amount of time that I spent with Josie. I found out a lot of things about her that I wish I hadn’t.

Among all the things that I found out about her, I was explicitly made aware of her prognosis, given her comorbidities. This was the summer prior to my entrance to medical school, and I had two degrees related to the biological sciences, as well as having spent a lot of time shadowing physicians so I had a relatively good grasp of how much trouble she was in. In reading the file, I felt like I was cheated of my plausible deniability; I realized in the moment how the weight of this knowledge would change our relationship. No longer could I look Josie in the eye and give her my full support, encouragement, and belief that she would one day be able to leave the ward of her own free will. Because I didn’t believe that anymore. If I were to tell her the same things that I used to, I would be a liar. I would have broken the trust that existed between the two of us (in my mind). But there was also no doubt in my mind that this was what Josie needed some days – someone to tell her that everything would be alright no matter how bleak her day had been. Someone who could provide her with unbridled hope and optimism when she had none to draw upon for herself. I was angry that the volunteer coordinator had taken that from me. That I could no longer be that person for Josie.

I had had my reservations about the amount of patient information that the volunteers were able to access for some time, but I finally mentioned to the volunteer coordinator after that day that I did not know how comfortable the other volunteers were with Josie given how much they knew about her. Some of them were in high school on their co-op placements, some just starting out in their university careers. The coordinator’s response was that she had asked them and that they said that they felt fine. I was slightly surprised and expressed mild dismay on the outside, but internally, I was apocalyptic. These were some of the things running through my head: How would the students know what they were okay with and what they were not? Many of them haven’t even developed emotionally enough to understand what they were feeling. In addition, it is such a coveted thing to volunteer in a hospital with so much patient contact at such a young age – would any of them ever jeopardize something like that by stepping slightly out of line in questioning the appropriateness of their duties? The power differentials were huge in my mind. And Josie is a complicated patient, even beyond the multiple comorbidities that she has. Josie’s suicidal ideations were nothing to scoff at – she was on suicide alert and not allowed to be provided with any vaguely sharp objects. Did any of these young men and women even understand the complete implications of someone attempting to take their own life?

And today, after relaying some of these thoughts out loud in professional competencies, I now realize that not everyone sees patients in this manner or is affected this deeply. I now realize that perhaps the volunteer coordinator’s response was appropriate given her knowledge and understanding of her volunteers. One of my longitudinal facilitators mentioned (correctly, in my opinion) that perhaps I may have been projecting my own feelings and concerns onto the younger volunteers – and I now realize that this is not the first time I’ve done that. After a tutorial session, I made the remark that everything that we’ve been studying so far eventually leads to death – we are essentially studying death. How to delay it, or how to make it as comfortable a process as possible. This was right after we finished the case with Teresa in respirology (aspiration of vomit, poorly controlled diabetes, difficult psychosocial situation, three days of vomiting) – the first case in my opinion where the outcome of death was a certainty. And no one in my tutorial reacted visibly to that statement. I understand now that I was projecting a bit – everyone deals with patients, medicine, and loss in their own way, and it would be extremely incorrect of me to judge my colleagues. Perhaps they felt a massive amount of internal turmoil that they did not have words for. Perhaps behind their blank (and tired) faces they felt as sharp a sadness as I did. Or perhaps I am just emotionally ‘thin’ and as such am easily distressed.

Unfortunately, in our line of work, it’s impossible to avoid loss. Even the ‘safest’ and ‘most insulated’ specialist will encounter death in one manner or another. I’ve realized that I need to figure out which ‘losses’ to carry with me as part of my professional baggage and which I need to let go for my sake and theirs. I wish I can share this realization that I’ve come to with my colleagues – but I’m afraid that some things are best learned through experience. I think I experienced loss in leaving Josie and that this loss accentuated this realization. I left her, saying that we’ll see each other soon. But even as I said that, I was pretty sure that I wouldn’t see her again at the end of my medical training.

This is my fifth week of medical school. I am learning to reexamine why I have chosen medicine, especially as it pertains to which specialty I might wish to pursue. I care about my patients – you can tell by the fact that I choose to use the pronoun ‘my’, even though I have never admitted a single patient into a hospital – nor do I have a single patient on my roster. And yet I already think of them as ‘mine’. I hope I do not come across as pretentious in saying so. This is just how I feel. I also am attracted to the intellectual aspect of medicine. But the deep yearning underneath is something I am afraid of. I am afraid that I have chosen medicine because of my attraction to loss, pain, and misery. I am reminded of a quote in the foreword of Cutting for Stone by Abraham Verghese.

“Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our woundedness. And it can. But it can also deepen the wound.”

In the context of this quote, I am afraid of what this means about me. That I am looking to heal the most broken of people. That I am attracted to cases of hopeless neuro-pathology such as Parkinson’s Disease. That I wonder on a regular basis about the future of palliative care. And serious cases of heart disorders. Or patients who have the bleakest of hopes like Josie. Because I kept on coming back and visiting her even after I realized her prognosis. What does this say about me if Verghese is correct in stating that people become physicians in the hope of healing themselves? What does this mean if my natural inclination is to chase after the hopeless, the lost, and the worse off of humanity? Is it Christ’s nature in me compelling me to chase after the lost, the weary and heavy-laden and provide them with rest? Or is it indicative of a need to dive deep into myself to find what it is that needs to be healed lest it be too late and I end up irreversibly damaging myself and my future patients? Perhaps time will tell. But more likely than not, I do not think I will obtain the answer in time to do anything about it. In my opinion, that is the course of most of life’s most vexing questions. They are vexing, and will remain so until one day they no longer bother you. And in the moment that you learn to let it go, the answer will be stumbled upon – and yet the answer is no longer useful and will be entirely inconsequential given the way that your life has run its course.

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