Category: Narrative

Categories
Empathy General Mental Health Narrative Psychiatry

From Her Mind to Mine

By Jessica D Simon

Walking down the familiar dead-end hall of Psych 2, I nearly walked right past the thin woman almost drowning in her hospital gown as she calmly allowed the nurse to take her vitals. I stopped to confirm her identity and introduce myself. “Oh hello, how are you?” came the polite response. Stories of Betty had wafted down from the consult-liaison team for the past week with a macabre fascination. Her image was contradictory; it seemed implausible that the frail, proper lady sitting in front of me, hair pulled neatly back into a graying ponytail, had just a few days prior made the desperate decision to violently shoot herself in the chest with the intention of ending her life.

I held my breath in anticipation, unable to deny my excitement at being assigned to this case followed immediately by the familiar sensation of guilt. How can I be fascinated by someone’s dark tragedy? I would soon learn that this dissonance, walking the line between compassion and self-gratification, lies at the heart of providing effective psychiatric care.

We exchanged pleasantries as together we made our way to the optimistically named “comfort room,” home to one large battered upholstered chair, a modest wooden table, and a window with an AC unit, culminating in a poor excuse for a respite on Psych 2. Betty shuffled slowly, still healing physically from her wounds, until finally making it to the red armchair where she would spend much of her time over the coming weeks. She looked at us expectantly with a hollow stare. She had a defeated yet pleasant energy about her, and the gentle wrinkles surrounding her dead-set gaze told me that I was sitting in front of a woman whose life I knew nothing about.

Betty met her husband Steve in high school, forming an immediate infatuation that continued to blossom into 45 years of loving marriage. They had no children and spent their days attending church, going for long walks with their dogs, and volunteering together in the community. Their lives were filled with a beautiful simplicity that bestowed long-lasting contentment, a sentiment for which many spend their whole lives searching. When Steve was diagnosed with an aggressive glioblastoma on September 1, 2021, Betty’s life quickly evolved into an endless cycle of hospital appointments, research, and clinical trial investigation. Yet she helplessly watched as Steve’s condition steadily worsened, his movements slowing and memory fading. In May 2022, when Steve failed multiple clinical trials, Betty fell into a deep despair that ultimately pushed her past the precarious edge of desperation.

Betty’s hopelessness was palpable, leaving an icy chill hanging in the room. I was alarmed to find myself feeling her agony to the extent that I almost wished for her sake that she had fulfilled her wish to die. I knew I could not promise this woman that she would have a happy future, devoid of the comfort and love that she had shared with a now dying man for the greater portion of her life. I took a deep breath. Working with Betty, I would slowly realize the therapeutic power of carrying the hope that individuals have lost in the flooding sea of mental illness until they again emerge and attempt to swim.

On Monday, Betty’s third day of admission, we received news that Steve had passed away in hospice earlier that morning. I hesitantly approached her for our usual session, preparing myself for an explosive encounter. I was shocked to find her eerily calm, her tone level, her response rational, her composure unscathed. She stared at me with the same dead eyes and motionless face that seem to challenge me, now what?

Betty guarded her true emotions with years of protective layers built from privacy and stoicism, speaking slowly with stiff unmoving facial features. I spent hours sitting across from her, watching her sip her two vanilla ensures that she ordered for lunch and racking my brain for how to engage her in a therapeutic relationship. A two-hour session with her felt equivalent to about twenty minutes of meaningful conversation, and for days it felt like we were getting nowhere. One day she said, “No one actually cares. You come and talk to me, but you don’t think about me once you go home.” Remembering the numerous times I had neurotically checked Epic late at night, my immediate unfiltered reply came, “actually I do think about you when I go home.” I saw her face soften ever so slightly, yet immediately regretted responding with my own emotional response rather than creating a space for self-reflection.

This moment brought me face-to-face with my own humanity and its effect on my patients. My response had centered myself in her healing, needing her to see my goodness and selfishly wanting our relationship to be special to her. The real question was why had she made that statement in the first place? The grief of losing her husband had clearly left her in the depths of an extreme loneliness, and this statement had unveiled a desperate longing to be held. An opportunity to guide her towards conscious awareness of her deepest desires became instead a chance for me to prove my compassion, a band-aid for her depression. I began questioning my habit of spending two hours daily speaking with her. What expectations was I setting? Was I doing it for her or for me? Doctors of course are all human, affected by the accumulation of past life experiences with flaws and strengths alike. I now realized the extreme importance of having self-awareness and acknowledging my own emotional needs as a future psychiatrist.

Betty thanked me politely after each session, maintaining her image of a proper, well-brought up woman despite her circumstances. As we approached more difficult questions, her eyes would close tight with a wide grimace that displayed all her teeth, the veins in her face tensing with discomfort – a look as if she was about to break-down into heaving sobs. Yet I never saw her shed a tear. Over time, I slowly began to see changes in her as she learned to label her emotions, reflect on her self-isolating nature, and even display a forward-thinking attitude about what her future life may look like. Eventually, she entrusted me with the information that her suicide attempt had been a “joint act” with her husband, in a Romeo and Juliet moment where they had felt that life was not worth living without one another.

It is hard to know how to react to such information, and my mind swarmed with questions and wonder upon this disclosure. The juxtaposition of romance and violence was truly something out of a movie. I was struck by the commitment of their love, yet deeply saddened by the decision to which it had led. Is love dangerous? Is grief inescapable? Are parts of life worse than death? Betty’s story was a reminder to withhold assumptions, and in the world of psychiatry it is often better to ask questions than it is to demand answers.

On her day of discharge, I stared at the familiar phrase in Epic that I had copy and pasted many times: “Betty Wolff* is a 64-year-old female who presents after a self-inflicted gunshot wound to the chest s/p pulmonary wedge resection.” The brief summary evoked alarming images of the well-intentioned, loyal woman I had gotten to know intimately over the past couple of weeks. As I watched her walk out the door that day, neatly dressed in the button down and tennis shoes that her brother had brought, a wild mix of emotions swelled inside me. I felt proud to have played a role in her recovery process yet fearful of how she would respond to her new reality.

Psychiatry is wrought with uncertainty, with mistakes potentially resulting in devastating consequences that can keep you up at night. Yet I found solace in knowing that we had given Betty the potential to reclaim her life after unimaginable tragedy had left her in the dark sea of hopelessness. Everyone deserves that chance. I left my rotation with a deep appreciation for the complex nature of psychiatry with an increased comfort in relinquishing control over the unknown, acknowledgement of our shared humanity and limitations as clinicians, and an acceptance of the unpredictability of life and fellow humans.

And when Betty returned to the unit two days after her discharge having asked her brother to kill her, I learned to see this not as a failure but as a small stepping-stone in the complex journey to recovery.

* all names and identifiable information have been altered for patient privacy

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Categories
Clinical Emotion General Humour Lifestyle Literature Medical Humanities Narrative Reflection

On Playing Doctor

An excerpt from “Playing Doctor: Part Two: Residency”

By: John Lawrence, MD

As was her habit, she [the surgical chief resident] had called to check in with a surgical nurse to see how each of her patients was doing. They were discussing each patient when the nurse stopped to mention that there was a code team outside a room on the sixth floor with a collapsed patient.

My girlfriend quickly realized that it was one of her patient’s rooms, then raced back to the hospital, sprinted up six flights of stairs, and dashed onto the sixth floor, where she encountered a chaotic group of people surrounding one of her patients lying unconscious in the hallway.

The internal medicine residents and attending physician running the code were about to shock the unconscious patient because he had no pulse. As we’ve discussed previously, no pulse is bad.

Suddenly, in the middle of their efforts, and much to everybody’s surprise, the 5’1” surgery chief ran up, injected herself into their midst, ordered them to stop, and demanded a pair of scissors.

Nobody moved. The internal medicine attending exploded, wondering who the hell she was and what she was doing. It was his medicine team in charge of the code, and this patient had no pulse. Protocol was shouting for an immediate electric shock to the stalled heart.

Paying little or no attention to his barrage of questions, she grabbed a pair of scissors and now, to everyone’s complete and utter shock, cut open the patient right through the surgery wound on his abdomen.

Let me recap in case you don’t quite appreciate what’s going on: she cut open a person’s abdomen in the middle of the hospital hallway—and then stuck her hand inside the patient!

When the chairman of surgery came racing down the hall, he found his chief resident on the floor wearing a full-length skirt, with her arm deep inside an unconscious patient, asking, “Is there a pulse yet?”

The furious medical attending was shouting, “What are you doing? Are you crazy? What are you doing?”

And she kept calmly asking the nurse, over the barrage of shouts and chaos, “Do you have a pulse yet?”

Suddenly the nurse announced, “We’re getting a pulse!”

Which immediately quieted everyone.

Being an astute surgeon, she remembered thinking that the patient’s splenic artery had appeared weak when they operated on him. She correctly guessed that the weakened artery had started bleeding, and that his collapsing in the hallway was due to his rapidly losing blood internally. She had clamped the patient’s aorta against his spine with her hand to stop any further blood loss.

From the sixth-floor hallway the patient was rushed to the O.R. with my girlfriend riding on top of the gurney, pressing her hand against his aorta, keeping the guy from bleeding to death.

She then performed the surgery to complete saving his life.

The guy took a while to recover. Being deprived of blood to the brain had its detriments; when he awoke, he was convinced the 5’1” blond surgeon in the room was his daughter. When he was informed that no, she wasn’t his daughter, he apologized, “Sorry, you must be my nurse.” That comment, one she heard all too frequently, did not go over well.

To put this somewhat crazy event into perspective, within a day or two, the story became the stuff of legends told throughout surgical residencies across the country—and this was before social media sites existed to virally immortalize kitten videos.

Opening a patient in the hallway and using her hands inside the guy to save his life? This feat, treated by her as nothing more than a routine surgical moment, was akin to knocking a grand slam homerun in the ninth inning of the World Series in game seven to win the game—well, something like that. It’s what little kid wannabe surgeons would dream of if they cultivated a sense of creativity.

And to be fair, I thought it was an exciting episode, but she was always running off to save lives as a surgeon. The moment however, that finally put this accomplishment into perspective for me occurred when I was having dinner with her brother, the ace of aces surgeon, along with several other all-star surgical resident friends. This was a few weeks later, and without her present.

Eventually their surgery discussions (because that is pretty much all that this group of surgeons discuss when stuck together: surgery, ultra-marathon running, and more surgery) turned to loudly bantering back and forth about the whole event.

They boisterously argued about how much better they would have handled the whole situation, and wished they had been there to save the day instead of her:

“You dream of something like that going down.”

“Can you imagine being that lucky?”

“Should have been me.”

“Oh man, I would pay to have something like that happen.”

All the young surgeons agreed that this was their medical wet dream, being the rebellious action hero, on center stage, in such a grand case, in the middle of the hospital, no less, calmly saving a life in front of everyone with attending physicians yelling at you.

Then there was a moment of silence, total quiet as everyone reflected on the event…

“But you know what?” her brother finally said, looking around at everyone, then shaking his head and chuckling, “I never would have had the balls to do it.”

And every single surgeon around the table slowly nodded their head in agreement—they wouldn’t have either.

True hero.

Playing Doctor: Part Two: Residency is a medical memoir full of laugh-out-loud tales, born from chaotic, disjointed, and frightening nights on hospital wards during John Lawrence’s medical training and time as a junior doctor. Equal parts heartfelt, self-deprecating humor, and irreverent storytelling, John takes us along for the ride as he tracks his transformation from uncertain, head injured, liberal-arts student to intern, resident and then medical doctor.

Categories
Emotion General Global Health Healthcare Disparities Interview Narrative Reflection

Out There: Part 1 (An Interview Series)

Trimbekshwar Temple
Out There: Part 1

By Janie Cao
Edited by Mary Abramczuk


I met Thanos Rossopoulos through a community service leadership program. As with almost everyone I’ve met, I stereotyped him at first glance (subconsciously, of course). I thought that he was going to be like most other first-year medical students I’d met before—smart, hardworking, and…pretty fresh from college. And guess what? I was only mostly right.

The first time I heard him share his story, we were at a group dinner. I was sitting too far away to hear everything but at the perfect distance to want more. He said something about ‘7 gap years,’ the oil and gas industry, and living in India. That was enough to nag at my curiosity, so I unashamedly asked for an encore. He graciously obliged.

Like many people in their early twenties, Thanos wasn’t quite sure what he wanted to do with his life when college graduation arrived too soon. He remembered that at the time, he’d just wanted to do something exciting, something risky, something “radical.” So when they offered him an engineering job that would put him in the oil rigs of India for one and a half years, he said yes. There, for the first time in his life, Thanos stared into the glare of deprivation. Not really what he wanted, but perhaps what he really needed.

Growing up in Orange County, California, he had been raised in a privileged “bubble,” as he called his sheltered childhood. But he didn’t know how sheltered he was until he stepped foot into India, where he saw mansions and slums coexisting side by side, all in broad daylight. “It took India to force me to face inequality,” Thanos reflected, “and it didn’t sit with me well.” What he made sound like ‘just a slightly uncomfortable feeling’ was in fact the beginning of a tenacious zeal to alleviate human suffering. He was a tad modest.

The impact of those years in India manifested powerfully after he returned home. Whereas in the past, he did not even know to look for inequality, now that was all he could see around him. So, what did Thanos do next? What would you have done?

To be continued…

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Photo Caption: "...Taking a stroll in the morning before my shift on the oil rig. If you look closely out in the distance you see the top part of the oil rig I worked on behind the trees. This was from a small village called Radhapur in the state of West Bengal. Very beautiful place." -Thanos Rossopoulos
Categories
Emotion Empathy Narrative Poetry Reflection

When Love Gives Way to Lies

When Love Gives Way to Lies
By Janie Cao
Edited by Shaun Webb
One evening on my way back from a hospital shift, I saw a woman staggering along the street. Half walking… half falling… It looked like she was trying to get back home after spending some time at the nearby bar.

I didn’t know how I was supposed to respond as an almost-doctor. But it didn’t feel quite right to just leave her be, especially when she was drunk and in the dark, all alone.

By the time I drove to her, she was already in the parking lot of her apartment complex. I got out anyways, just to say “Hi.”

I remember when she turned and looked at me. She paused. And in those moments of silence, I saw heartache.  There was also sadness, anger, and a pain that would leave marks. It didn’t matter that she didn’t know me enough to trust me. There was too much hurt to hide. As I watched her eyes, I remember wanting so much to stop her from feeling that night.

Finally, she chuckled and smiled bitterly. “My husband…” she said. Then she gave me a kiss goodbye.

She never finished her sentence, but I wonder if it had something to do with this: that when a husband hurts his wife, and love gives way to lies, it can simply be called life. I went home after, and cried.

----
based on a true story

Photo credit: Bernard Laguerre



		


	


	

		
		


			

		


		
	


	






	



	


		
			

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					Clinical Emotion Empathy General Humanistic Psychology Narrative Palliative Care Poetry Psychiatry Psychology Reflection Spirituality				

			


			
The Dying Man

		


			

		


		
	





	


		


			
		


	


	
	


		


			
The Dying Man
Written by Janie Cao
Edited by Mary Abramczuk


A few years ago, I spent half my day with a dying man. I remember these things about him: his name, his past profession, and that he was dying alone.

I never saw his résumé, the size of his house, or how much money was left in his bank account. I was not curious to know, either. But I bet they seemed significant once upon a time, at a dinner party, maybe. He worked as an engineer.

On that day—the day he died—no one who had cared about those things was there.
I was a stranger, yet I saw his last breaths. It was a curious day.

This world teaches us to do many things. To set goals (S.M.A.R.T ones, in fact) and to meet them. To maximize profit and minimize loss, and to use other people, to our advantage. We learn to build storage houses and efficiently fill them with glorified trash; to talk like we matter, and live like it, too.

Someday, we will all be that dying man. Not fully here, and not quite there; mere wisps of breath. When that day comes, will this world be at your bedside? 
Sometimes, I wonder.




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Dedicated to a friend: May you find what you are searching for.
Photo credit: Jörg Lange


		


	


	

		
		


			

		


		
	


	






	



	


		
			

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					Emotion Empathy General Humanistic Psychology Narrative Public Health				

			


			
Guter Mann

		


			

		


		
	





	


		


			
		


	


	
	


		


			
This city is so peaceful. As the bikes whiz by, I notice the absence of the cacophony and polluting fumes of traffic. I’m walking down the sidewalk in brown leather shoes and a tucked-in dress shirt while eating bougie gelato. I love gelato. I look up and notice the blue sky. It’s a deep blue and the clouds have distinct borders. I’m in Salzburg, Austria for a conference and I’m loving this city. Just as I marvel at the clean streets and begrudge the abundance of luxury vehicles, I turn the corner and see my sister on the floor asking for money. I immediately cross the street and reach in my pocket to hand her the change I received at the gelato stand. My sister is donning the flag of Islam on her head and I greet her with the anthem of Islam, a greeting of peace. She smiles and says, “Allah yijzeek al-khayr” – God reward you with the good. As I walk away, I smile at the beauty and seamlessness of our interaction.


I continue walking back to the conference hall. I review my rehearsed words as I finish my gelato. My presentation is on the data I generated regarding the controversial use of bisphosphonate anti-resorptives in the setting of chronic kidney disease mineral bone disorder. The nephrologists in the crowd won’t be too thrilled. In my head, I am considering all the different questions I could be asked, when I see another of my friends on the corner of an intersection. As I approach him, he brings his hands together and bows his head. When he raises his head again, I smile at him. I don’t have any more change so I reach into my pocket and hand him 5 euros. He has a cup in front of him, but I decide to hand him the money. I think this might make the money more of a gift than a charity. I can see hurt in his eyes as he tries to find a way to thank me. Reaching out I put my hand on his shoulder and squeeze, pointing up with my other hand, trying to tell him that I will pray for him. While my hand is on his shoulder, he turns his neck and kisses my hand. I say, “No, no!” and withdraw my hand. I feel ashamed. I know I should be the one kissing his hand for accepting my miserly gift of 5 euros while knowing full-well that I have another 10 laying comfortably in my pocket. Ten euros that I will, over the next couple hours, undoubtedly spend on a sacherwurfel from the bakery next to my fancy hotel and then on another helping of overpriced gelato.


Lost in my thoughts of embarrassment, I begin to walk away, and as I do, he yells in German, “Guter mann!” – good man. Halfway across the street, I think to myself, I may not be a good man, but I have the opportunity to try, and so I turn back around.


Ten euros was all the money that I had left on me. But 10 euros was all it cost to earn the respect and love of a man I had only met minutes ago. Excitedly, the man begins to talk to me in German. His name is Damien. (We spend a good 5 minutes on my name. I would say, ‘Mo-ham-mad’, and he would then repeat after me, ‘No-han-nam’). Damien is a father of 3 kids. He was doing well for his family until his wife lost her vision. He said, “Now my heart is still good, but children’s stomachs are empty, so my hand is outstretched.”


I notice the tears in my eyes. I had never heard German spoken before, and I shouldn’t know what he’s saying to me, but I understood every word. Home is where the heart is, and this man is my neighbor. As I leave Damien for the second time, I point up again and then turn my palms up to the Heavens in prayer. He says, “Allah.” And I repeat, “Allah.”


On my second day in Salzburg, I take the long way to the conference center, hoping to run into my friend Damien. I turn the corner and there he is, sitting at the end of the block. My stride lengthens and my steps quicken. As I approach him, I see him leaning left and right, squinting his eyes; he’s trying to see if it’s me. He leaves his corner and yells, “Nohannam!!” while jogging towards me and we embrace each other as brothers and lifelong friends. And as my neighbor and friend embraces me, I realize I may not be a good man, but Damien is willing to show me how to become one.


Photo Credit: Sam Rodgers


		


	


	

		
		


			

		


		
	


	






	



	


		
			

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					Emotion Empathy General Humanistic Psychology Narrative Patient-Centered Care Psychology Reflection				

			


			
Immigrant’s Suitcase: Ordinary people with the will to do extraordinary things

		


			

		


		
	





	


		


			
		


	


	
	


		


			
A mother separated from her missing husband flees a war-torn country, her homeland, to provide a brighter future for her children. She’s a dentist by training and practiced dentistry back home; but here, here she’s cleaning homes for a living. Why? When she left her home with her four children by her side, headed to a safer place, to America, what was in her suitcase? Alongside the picture of her missing husband and the few possessions that remained after the destruction of her home, in her suitcase, she has hopes and dreams, fears and doubts. She looks to her children for strength, but she’s terrified every time she looks them in their eyes. She is not optimistic, but she is hopeful; she looks the odds straight in the face and proceeds anyway. Because hope is not logical, it is powerful.


She’s cleaning the home of a happy family; the father is an engineer and the mother is a doctor and the children play piano. Their life, their hopes, goals and dreams are dependent on the stability of their country, but they cannot see it. The same hands that used to place crowns to relieve the pain of the suffering are now scrubbing the floor of another woman’s bathroom. But hope is powerful, and she lives through the dreams of her children. Two of her daughters want to be doctors. Her third daughter wants to be an artist. Her son is eight and he loves math. In her suitcase, she brought with her the dream of a better education for her children. “In Syria, we ate grass. In Egypt, we didn’t have food. In Indiana, I love school.” These are the words of her eight-year-old son.


A man runs to catch the bus. He can’t miss the interview; he really needs this job. It is his third interview in as many days. His last job got him enough money to get his family off the streets for a couple weeks. But motels are more expensive than he ever imagined. He’s homeless. His family is homeless. This wasn’t a possibility he considered when he graduated with his MBA. He had a great job, but the hurricane took everything away. And he hasn’t been able to get back on his feet. He catches the bus and pays the $1.75 in quarters. He checks the email that he printed; the interview is in room 4015. He runs up the stairs; he really hates being late. As he enters his interviewer’s room, a bead of sweat runs down his forehead. What’s in that bead of sweat? Desperation and nervousness, humiliation and self-pity, purpose and resilience.


His interviewer gives him the job offer. He smiles and shakes his head. A tear runs down his face. He can’t take the job; he can’t manage the branch that makes most of its revenue through alcohol sales. Another day and another interview, but his family remains homeless. He needs the job, but rejecting the offer was an easy decision. He believes that although alcohol may have small benefits to people and society, the harm it causes is much larger than its benefits, and wants to play no part in its distribution; he will not be a co-creator in the intoxication of his neighbor’s mind.


A young woman sinks into herself on the examination table. Her husband is holding, squeezing her hand. The doctor is still talking. He looks very sympathetic. The young woman just learned that she has a cancer growing inside of her lungs, an aggressive cancer. The doctor thinks ‘we can fight it.’ The young woman’s mind is overwhelmed into quietness. All she can think about is her daughter’s play after school that she doesn’t want to miss, even for this. The doctor brings her back, ‘Do you feel comfortable about our next step? I think that’s the best place for us to start.’ The young woman shrugs. What is in that shrug? Fear and uncertainty, peace and tranquility, ambivalence, a need for normalcy, a desire for time to make meaning.


The young woman is herself a physician, trained and licensed as a radiologist. She knows enough about cancer and the late stage non-small cell lung cancer she has been diagnosed with to know that the longevity of her future has been called into question. And yet this is not the topic of discussion with the doctor. Instead, he discusses treatment options, which is fancy talk for a long list of big words in different orders and combinations. When asked about the next step, she shrugged. She shrugged because there didn’t seem to be room for her in that room. (Insert young woman with terminal cancer here). Although it is more comfortable for the doctor to rattle off treatment options, the patient wants to take time to acknowledge the inexorability of our life cycle. To the doctor, it was the end of a beginning, and they were, together, supposed to begin a new chapter of strength and resilience. While he rattled off treatment options, she just wanted to catch her daughter’s play after school, and she was running late.


In the words of HL Menken, ‘For every human problem, there is a solution that is simple, neat, and wrong.’  Without taking a moment to explore what’s inside the immigrant’s suitcase, the homeless man’s bead of sweat, the sick young woman’s shrug, we stand a sorry chance to witness, help, and learn from ordinary people with the will to do extraordinary things. This is the power of narratives; the power of listening. I call myself to look inside the suitcase, to investigate the bead of sweat, and to ask about the shrug; I call myself to listen.


I find myself in an imperfect world, full of injustice and oppression. I find myself an imperfect man perfectly given the ability to alleviate suffering, on a personal level with a smile or a hug, and on a larger scale by fighting injustice and refusing to stand idly in the face of oppression. Poverty belongs in a history museum. And hunger…we have enough food in the world for every member of the human family to eat a balanced 3000 calorie meal. When we eliminate poverty and hunger, there will be many other injustices for us to face. I want to make facing these injustices my mission. My mission is to be ‘human’ as best I can; to work to establish justice in any capacity that I can, from a generously given smile to an honest political campaign.


Photo Credit: Robot Brainz


		


	


	

		
		


			

		


		
	


	






	



	


		
			

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					Clinical Emotion Empathy Narrative				

			


			
Tears of a Child

		


			

		


		
	





	


		


			
		


	


	
	


		


			
I walked up to my dad and said, “Baba, there’s something wrong with me”. I was probably around 8 years old at the time. He looked concerned and prompted me to tell him more. I said, “I cry a lot. About everything. And my brother and friends make fun of me.” He then smiled and, through his smile, said words that will stay with me forever. “Don’t worry Mohammad. It’s a sign of a soft and warm heart. Your special mission is to travel through this life and keep your same soft heart.”


Fast forward 10 years to my second year of medical training. I remember entering a patient’s room as a part of our Introduction to Clinical Medicine course. Moon face. Truncal obesity. Buffalo hump. Abdominal striae. Hirtuism. I was like a child with a fulfilled Eid gift wish list! Here I was, celebrating my ability to recognize the quite obvious presentation of Cushing’s syndrome, oblivious to the very real and detrimental complications of Cushing’s syndrome and the emotional toll that these symptoms must be having on this young woman. She entered the room to receive care, and I entered the same room so focused on my ability to produce a differential diagnosis that I failed her and myself; I failed to show her the compassion that fuels my love for medicine. My inability to see past the mere facts of her presentation left me in a poor position to honor my mission. Fueled by the tears of a child, I cried.


 


Photo credit: Quinn Dombrowski


		


	


	

		
		


			

		


		
	


	






	



	


		
			

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					Clinical General Lifestyle Narrative Opinion				

			


			
In the Business of Medicine, Be Your Own Boss

		


			

		


		
	





	


		


			
		


	


	
	


		


			
As medical students, we exist between two worlds. On the one hand, we’re tasked with learning as much as we can about the practice of medicine from our preceptors, many of whom have decades of experience. On the other hand, we’re always thinking about our place in the future of medicine and fantasizing about what our unique style of practice will look like. While I feel indebted to the seasoned physicians who graciously give of their time to teach us, a recent interaction reminded me that I am the boss of my own practice of medicine.


It started out as a morning just like any other. I needed to finish rounding on my patients before a noontime meeting where I was slated to give a small presentation. The last patient on my roster had been particularly troublesome for our service. She had been admitted for worsening congestive heart failure and although she was relatively young, and had a very supportive family, she did not seem willing to make any of the lifestyle changes that would improve and possibly prolong her quality of life. Nurses, doctors, and respiratory therapists had been trying to get her to wear her CPAP mask during this hospitalization, but for reasons that we didn’t completely understand, she had been refusing to wear it for the past two months.


After a quick exam and what seemed like a futile imploration to try her CPAP again that night, she started telling me a bit about her life prior to becoming ill. I knew the time was coming closer and closer to my meeting, but I couldn’t leave while she in the middle of divulging such personal information. Our conversation dwindled, and I stepped toward the door, when she tearfully mentioned that her dog had recently died. Again, my thoughts drifted toward the upcoming meeting, but I also wanted to be sensitive to this very meaningful event in my patient’s life. Trying to be polite, I asked when her dog had died.


“Oh, about two months ago,” she replied.


I paused. “Is that about the time when you stopped wearing your CPAP mask at home,” I asked.


She stopped to think. “Yes, I think it was exactly around that time.”


Thinking that the timing of her dog’s death coinciding with when she stopped using CPAP might be more than coincidental, I offered my condolences for her loss, and assured her that I wanted to come back later in the day to talk more about her dearly departed pet. I felt relieved to see that I had only run a minute late, so I hightailed it to the meeting. As I stopped to pick up the materials for my presentation, I heard my attending calling my name from the hallway. I couldn’t wait to tell him that I had stumbled upon a very useful piece of information to help us understand why she stopped using her CPAP machine.


“I know I’m a minute late-I got stuck with our patient,” I explained. “I couldn’t just couldn’t leave when she started talking about her dog who recently died, but I may have a clue as to why she won’t wear her sleep mask.”


He looked dismayed. “You have to figure out how to get out of those conversations,” he told me curtly. “That’s just the business that we’re in.”


His last words “the business that we’re in” struck me so profoundly that I can still replay them in my head as clearly as if he was standing right across from me. I have not had a temper tantrum since childhood, and yet, in that moment, everything inside me wanted to shake my head and bang my fists in passionate disagreement. I understood immediately that whatever business this physician is in is not the same business I’m planning to go into. As a student, I still have a lot to learn, but one thing I know for certain is that patients should always take precedence over meetings. After all, without fostering the relationships we have with our patients, medicine would be a business in bankruptcy.


Medicine has a rich history of being passed down from generation to generation, but like anything else, aspects of medical practice may become antiquated. As the next generation of physicians, it’s up to us to hone our judgment and decide whether we will accept the status quo or make a new path forward. We get to decide what the business of medicine means to us. Whether we work for a large corporation or go into private practice, each one of us is a boss-in-training of our own future practice. It took some not so sage advice from a preceptor to remind me that meaningful and collaborative relationships with my patients are the cornerstones of my business of medicine.


 


Photo credit: Christophe BENOIT


		


	


	

		
		


			

		


		
	


	






	



	


		
			

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					Clinical Narrative Reflection				

			


			
Red Rash

		


			

		


		
	





	


		


			
		


	


	
	


		


			
As I sat in the audience, I stared up at the image being presented on the screen. It was what looked to be another red rash. The content for the Dermatology grand rounds was admittedly beyond my clinical training. Nevertheless, I found it fascinating to slowly discover the complexities of the skin as each case was presented. As I thought about each slide I began to ponder Dermatology as a specialty. I wondered what it meant to be a dermatologist. I briefly reflected on the stereotypes associated with the profession and then realized that every specialty had stereotypes. My brief daydream was interrupted as the next image on the screen appeared. I was anxious to see what it was in hopes that I could identify it, but to my dismay it looked like just another red rash.


Later, as I scurried behind the attending in my official looking, yet noticeably shorter white coat, I wondered what type of red rash I would be observing next. As I entered the exam room the woman sitting there immediately shocked me. Her face read of complete sorrow and hopelessness. However, it was not her face that struck me, it was her skin. It was red, dry, and seemed to be peeling off of her as if she was shedding her skin. It looked terrible and seemed to feel even worse. It was then that I saw the attending spring to life. He began discussing her symptoms with her. When he had gathered the information he needed she began to tell him how the illness has been affecting her life. Skin diseases or issues with the skin can sometimes be viewed or reduced to something inconsequential or unimportant compared to other serious diseases such as diabetes, heart disease, or cancer. However, as I looked at this woman, I imagined her waking up in the morning and standing in front of the mirror and being unable to focus on anything other then this rash covering her entire body. It was then that she described the shame, embarrassment, and humiliation she experienced when others would stare at her, whisper about her, or when she would occasionally catch a glimpse of herself in a store window. The thought of her disease staring at her in the face when she brushed her teeth each morning made other serious illnesses that hide under the skin seem preferable.


After listening to her describe her quality of life it made complete sense as to why she felt so hopeless. It was in the moment that I had a strong desire to help this woman. I wanted to relieve her of this suffering. Fortunately, the attending was already in action. He began to describe his treatment plan while validating every one of her feelings and concerns. It was as if he knew what it was like for her to lose sight of herself and only see her skin. As the sorrow slowly drained from her face, I saw something incredible, hope.


It was then I realized that every slide I causally coined as a “red rash” belonged to actual people who have lives, families, and most importantly feelings. I assigned them a label that they never asked for and most likely hide from everyone they encounter. Assessing and treating the human body is an immense responsibility, but so is connecting with people. Now when I see the images at grand rounds I no longer see a red rash. I see a person who with the proper treatment and compassion can become whole again.


 


Photo credits:


Featured– Jean-Pierre Dalbéra


In-text- Taylor Thomas