Liz's Medical School Journey

Last Friday afternoon I left the hospital, looking forward to my first two-day weekend in over a month.  As I started walking down the hall, I felt the urge to go back to tell Mr. Carlos* and his family what a pleasure it had been to be part of his care, and how much I had enjoyed meeting him.  I began having an entire conversation in my mind about whether I should return to his room.

Almost daily I catch myself yearning to show a more compassionate, more human side of myself to my patients.  Somehow I cannot seem to bring myself to do it: to offer my gratitude or condolences, to hold a patient’s hand, to hug somebody.  I want to bring a birthday card, or a cupcake with a candle.  I wonder is a candle flame allowed?  I want to offer one of my personal packs of soft tissues to a tearful patient because the hospital tissues feel like sandpaper.

I am paralyzed by my discomfort. No one else seems to notice anything missing.  Physicians who teach me by their example do not do these things.  As a third year medical student, it feels difficult to break convention, to try anything unique.  I make excuses, convince myself that patients probably do not want me to personalize their care this way—it would be “unprofessional,” or that offering the tissue or a cupcake might not be sterile or good for the patient’s health.  However, I still feel there are big gaps.

For example, I remember the woman I met last year with the black polka-dotted blouse.  Weekly during my second year of medical school I had accompanied her doctor as he saw his patients.  I still see her as she sat well-dressed and eagerly waiting on the exam table for her six-month follow-up.  I knew the bad news before I met her.  Her doctor said “suspicious nodules,” and her face broke apart as if a truck were crashing into it.  I just stood there, behind the doctor, part of “the wall.”  Inside I wanted to offer so much more.  And I didn’t offer anything.

One time I took a chance and asked a patient if he wanted me to hold his hand.  He was a young man, so I internally questioned whether my action was appropriate. But he was in so much pain; I couldn’t stop myself from asking.  Immediately, he reached out and squeezed my hand so hard it hurt.  It was validating.

I thought that affirmation would make it easier to reach out again, but it has not.  I knew he was just one of all the patients I would see and feel this way about.  Since then, I still feel an obstacle and a hesitation every time I reach my hand out.

I went into medicine because I love helping people, but often the silent boundaries of the hospital prevent me from doing the things that matter most to people.  Let us put aside handholding or cards.  Frequently I cannot even let patients sleep or eat regularly, nor allow them go to the bathroom without finding their nurse first.  I feel as if I must not let my colleagues know that I care too deeply about my patients.  My problem is that sometimes I feel like I care too deeply.  There is a fine line between humanity and professionalism, and I am still searching to find exactly where it lies.

Last Friday as I walked to my car, I mentally talked myself out of saying thank you to my patient.  I rationalized that I could speak with Mr. Carlos and his family on Monday morning.  He had been in my care for over a week with many ups and downs.  Now he finally appeared to be comfortable, stable and past the worst.  My colleagues would wonder why I was going into his room after rounds had finished.  There was no clear medical reason for me, the third year student, to go back to see him again.

He died over the weekend.

This entry was posted on Monday, October 4th, 2010 at 9:39 pm and is filed under 3rd Year, Death & Diseases, Family & Internal Medicine. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.