Recently, while discussing the case of a dying patient who was, despite the reality of her situation, far too young to die, I was struck by the overwhelming sadness of the hospital. Aloud, I said to the intern standing next to me, “Every day, we see multiple patients whose stories are actually too sad to be true.”
And yet, the stories were true. The 40-something-year-old father who survived several heart attacks in his 30s, only now to be dying of cancer. The previously healthy father of two young children who, all of a sudden, had a stroke and now can’t move the left side of his body. The new mother, diagnosed with postpartum cardiomyopathy, whose heart will never recover from the strain of her pregnancy and might even get worse.
In the last three weeks, I’ve seen these patients, live and in the flesh. It’s utterly, mind-numbingly, sad.
Mind-numbing.
I use this word consciously, and I mean it literally. The depth of suffering that one sees at Duke University Hospital actually has the power to anesthetize the part of the brain, or perhaps the part of the soul, that is capable of comprehending pain. It’s like the part of my brain that normally is very capable of thinking about suffering has gone to the dentist to get a tooth pulled, and the dentist gave my brain a shot of lidocaine and some laughing gas, and now everything is vaguely distant and dull.
For instance, I might walk into the room of a patient, an older woman with dementia, who neither knows where she is or why she’s there. I might have been told that this patient is here in the hospital because she passed out during breakfast and didn’t respond immediately when her daughter shook her and yelled at her. And I think, immediately, that this woman is not likely to live much longer, regardless of what is done or not done for her while she’s in the hospital. And I think, immediately, that she may have passed out from a myocardial infarction or a pulmonary embolus or aortic stenosis or an aortic dissection or a stroke or a seizure or ventricular tachycardia or maybe something else.
And not until much later, if ever, do I think about the woman or her family. Was the daughter scared when her mother was unresponsive? Is she finding it difficult coping with her mother’s illness? When the patient was slipping slowly into her current state of not-knowing, was it scary for her to think about where she was headed? Did she worry about being a burden, about scaring her daughter by passing out when she ate breakfast?
To some extent, this makes sense. As doctors (and trainee doctors), we’re supposed to think first about diagnosing and treating patients who come to the hospital, preventing the acute illness with which they arrived from killing them. We learn the six life-threatening causes of chest pain, and how to treat a patient with dangerously high blood pressure, and how to rapidly assess a trauma patient, because these skills will ultimately allow us to save lives.
The ultimate question though, is whether this mind numbing matters. Does it matter if doctors are slow to consider their patients’ emotional needs? The question of whether a physician’s ability to respond emotionally to patients correlates with the patient’s satisfaction with his care is an active area of research. I don’t claim to be an expert, but the data is equivocal.
But even in the absence of patient-satisfaction-driven data, it’s clear that numbness to human emotion is not a good thing. Personally, I remember reading my medical school admissions essay, full of idealism and energy, at the end of my first clinical year and realizing that the 21-year-old who wrote that essay might not have recognized the 23-year-old who was reading it.
Whether my patients were happy with me or not didn’t matter. I wasn’t happy. So I backed away from the textbooks, and for the first time in a year, I read some real books. Robert Penn Warren. Michael Chabon. David Foster Wallace. Eventually, my med school admissions essay made sense to me again.
Now, I try to temper my reading of the medical literature with my reading of real literature. It works for me. Others of my classmates go to the gym or do community service. Hopefully that works for them.
The point is that we (and you, if you choose this path) need to have something to re-engage the non-trainee-doctor portion of our minds. Whether or not it matters to our patients, it should matter to us.
Alex Fanaroff is a fourth-year medical student. His column runs every Wednesday.
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