In medical school, I took an elective class called The Healer's Art. Healer's Art is a course that was created by Rachel Naomi Remen, an author of many books on healing. Remen's own medical training was a huge influence on the creation of this program; medical school and residency are hard academically, physically, and emotionally. It's really no wonder why so many physicians are calloused and have difficulty relating to patients, but Remen rejects this "thick skin" defense mechanism and urges young physicians-in-training to explore themselves as people, people who have vulnerabilities and can recognize and empathize with others regarding their vulnerabilities.
We are on week 4 of 5 of our course at the University of Arizona College of Medicine. This is my third time through the course (once as a student, now a second time as a facilitator). Tonight will be my first talk in the large group setting, and the topic for tonight is "Beyond Analysis: Allowing Awe in Medicine." Life has been busy for our family lately, with scant time to reconnect with each other, let alone ourselves. My blog has always facilitated the latter process, so it seemed fitting to draft my talk here. Forgive me if there are topics that I've explored in the past!
I had been present at many a delivery before Elena was born, coaching moms push, directing their baby's body to the outside world, and handing the prize to proud parents. Watching my daughter make her entrance into this world was amazing. When pregnant, I often wondered what my children would look like, but a blurred face would be the closest I could get in my daydreams. After Elena's head and shoulders emerged, my doctor had me reach down and pull her onto my chest. The first thing I said to Josh, in true Rhode Island fashion, was, "She's wicked cute." She was taken to get dried, weighed, and medicated, and then given back to me as a nice little bundle. I spent the next two weeks in utter bliss as my baby snoozed away, happy to nurse when she was awake.
When Nina was born, the same birthing process ensued, but this time I asked my doctor and attendants to allow her to rest on my bare chest until she had nursed. In retrospect, my separation with Elena so shortly after her birth made me sad--I think we've more than made up for it, but I wanted to experience the magic of "skin to skin". When Nina, wet and wriggly, was placed on my chest, her warmth just melted into mine into a little love puddle. I believe that sensation will stay with me forever, as no experience has left so strong an impression.
These two exceptionally intimate moments of my life were shared with my husband, and no other family members. For that reason, they are incredibly special to me. Interestingly enough, they were also shared with 4-5 other people in the room--my doctor, nurses, techs. To me, the privilege of sharing in these intimate moments of people's lives is one of the most amazing things about being a physician.
I've always been nosy--maybe that's one of the reasons that I love being a doctor so much. People tell you *everything*. My patients have disclosed stories of their most happy and proud moments; devastating sexual and physical abuse; complacency with marriages of convenience; and thoughts regarding the last moments of their lives and beliefs of the afterlife. I'm not sure what I am doing to create such a safe space for people to share these things that they ordinarily keep secret, other than letting people talk. Often times there's not much I can do but raise my eyebrows, shake my head, and say, "Huh," allowing for silence as the other person finishes their story and their mind shifts back from their memories to the present moment. These disclosures work on so many levels--patients often feel better sharing things they've kept bottled up, and these stories help me to see the person in front of me in a richer context. The combination of those two things leads to a deepening of my relationship with my patients.
True understanding of the context of life often comes at the end of it. I met R and his wife my intern year during a hospital rotation. R had been having some nagging pain in his shoulder and a bump on his head--sadly, these ended up being metastatic tumors. R followed up with me in the office; he was healthy and in his 40's, and didn't have a primary care physician prior to his hospitalization. I managed his pain as he underwent chemotherapy and radiation; both were palliative rather than curative, but I don't think R understood that fully. He kept rallying himself to "get better." Before one of his last appointments with me, his wife called me to say she didn't think they'd be able to make it to the office, so I went to their home instead. R was lying in bed, with agonal breathing, and didn't respond to my touch or greeting. His wife had been trying to medicate his pain with the oral tablets I had been prescribing--how that was working was beyond me, as the man could clearly not coordinate a swallow. We changed his medication to a liquid form, and all I did during that visit was sit and listen to his wife tell the story of his life, and of their love. He died in a couple of days, and I went again to their home to pronounce him dead. His whole family was present, mourning. His brother asked me if I was his oncologist--I had to stifle a smile, as I don't know how many oncologists make two home visits in a 3-day span (though I'm sure there are some!). I went to his wake, and a few months later, his wife sent me a gift for Easter.
More recently, I was able to spend some time with J, an elderly woman with a strong Brooklyn accent and a lot of spunk. We spent time together in her hospice room, where she pondered what was going to come next. I asked her if she was afraid of dying, and she told me she was looking forward to death, as it meant seeing her mother and husband again. We talked about her childhood, her marriages, her daughter and grandson. We talked about her faith and mine, and how to address spirituality with my children.
These conversations and experiences inspire awe in that they happen between relative strangers who are brought together in a professional setting. There is great mystery to be uncovered when view our patients as people, and exploring the unknown based on our experiences. How lucky we are as physicians to be privy to such meaning in our day to day lives.
