Reflection

I wrote this assigned reflection paper for my surgery rotation. Since I did all the work, I figured I'd post it here. (Please note that some facts have been changed to protect patient privacy/information, and that my words here are simply private opinions and reflections and aren't an example of my institution's policies.)

***

He was 90 years old. Tall and lean, his quivering frame draped with translucent, papery skin through which I could see a mottled weave of capillaries and sun spots. My second-year resident stood at the head of the bed, injecting lidocaine into the edges of a deep 8 cm laceration on his scalp while two other medical students hung onto his head and his arm. I stood to the right of the gurney, and when the needle pierced the old man’s forehead, he let out a cry. As he began to strain against my grip I felt in his aging biceps the residual strength of what must have been a powerful man.

“No no!” he shouted. “ What are you doing up there? That hurts!” His cries and struggles continued despite pre-medication. He began to shake, eyes widening with horror as he looked at our faces through the fogged-up viewing pane of our eye protection. The cloying odor of urine drifted up from the man’s groin.

“Sir, we’re just trying to help,” my colleague tried to assure him. “You’ve had a nasty fall and we need to sew up this cut on your head.”

But the poor man shook and shook and cried, unable to process that the pain and the masks and the strange fluorescent lights glaring into his eyes were things that would help him, and the message that he had fallen and been injured was unable to make it past the haze of his Alzheimer’s disease. As I looked down into the trembling face of this man, my thoughts flicked far away, over the Pacific Ocean, to Hawaii, where my grandmother lives, the woman after whom I named my daughter. My grandmother was diagnosed a few weeks into third year with squamous cell lung cancer, metastases to the brain and acute, probably permanent, short term memory loss. Phrases from family email updates drift through my subconscious throughout the day, things like "she had to suffer through three repeat spinal taps" and "the doctors are discussing chemo/radiation options" and "she doesn't remember she has a great-grand-daughter."

My thoughts quickly snapped back to the present reality when the man I was supposed to be restraining pulled his arm out from my grip to swat at the needle in his forehead. I brought my attention to the task at hand, but this time my eyes were wet with tears.

***

I find that tears come easily these days, which surprised me to be honest. I was told to expect to feel coldness towards the suffering; I have heard other people say that it is a fight to remember the humanity of the patient. Nobody told me what to do about the opposite reaction, when the suffering of the patient and their family feels overwhelming, and when it becomes easy to identify with patients, such as in the case of the man with Alzheimer's described above. There are some images that are difficult to forget. What, I wonder, can good bedside manners do for the woman who blew off her face with a shotgun? Or the young man who was hit by a car, dying on a gurney with a broken neck while his family weeps? Or the man who shivers in his C-spine collar on the gurney, asking, Doc, am I dying, while the room pauses and the trauma surgeon leans over him with a sober face, and says yes, you are.

As a brand-new third year, my pasted-on smile and pathetic good intentions are completely at odds with the wreckage of humanity that rolls in through the trauma doors.

In the Bible, the book of Ecclesiastes (Chapter 1:18) says that "For in much wisdom is much vexation, and he who increases knowledge increases sorrow." There is a sense in which medical education is gaining a type of wisdom, insofar as we gain knowledge of the healing of the human body. The downside to such knowledge is that we know how things can go terribly wrong with the body, and I believe that in order to cope with the sad truths of mortality, we set up walls of imperviousness and develop our own protections against the suffering.

So far I have seen it is common, acceptable, and even a point of bonding among physicians to complain about their patients and decry spending even twenty minutes in a room with a patient's overprotective family. I am not condemning this; rather, I think that venting frustration is an important way to maintain psychological health in such a high-stress, high-stakes career such as surgery. However, I have been told by three separate individuals that I should consider a career in psychiatry simply because I demonstrated an act of courtesy: I handed a man a box of tissues because he was crying at the bedside of his obtunded son, whom he had discovered hanging from the garage rafters in an intoxicated suicide attempt.

I suppose I have a lifetime to develop the "hardening" that I was told would inevitably happen. And at this point in time, in all honesty, I do not consider my tears a weakness, or the demonstration of simple kindness to be wasted effort. When I see myself in my patients and identify with their pain, I find that I go the extra mile when I might be too tired to do so otherwise, and I am happier about doing it. I know that in my future lies the hectic years of residency, in which the time crunch and so much new responsibility will often preclude me from being as kind or as patient as I ought to be. And yet I can't help but feel that I should be setting the habit now of small demonstrations of humanity, and that these small acts will make a huge impact down the line on how I ultimately decide I will treat my patients.

I would hope that somewhere, whoever is treating my grandmother would have similar good intentions, and that rather than be upset at her lack of understanding, would have pity on her condition despite not knowing much about her life or having any attachment to her as a person. I think as doctors we owe it to our patients to have at least an appreciation for their fellow humanity and to be gentle with their place of relative weakness.