It is hard not to be touched by patient stories. Stories of illness, loss, struggle, abuse, and more. I am often been moved by them, at times feeling tears build only to blink them away and maintain my medical persona. For a time I felt that I should not let these emotions show. Last fall a friend shared a concept with me call moral injury. It is used with veterans that are experiencing long standing psychological consequences of combat exposure. As expounded by Dr. Jonathan Shay this involves the transgression of moral norms in a high stakes environment by someone in authority. He also talks of the need to share ones story as a path to healing. I immediately saw the applicability to medicine.
No veteran will every trust you if you conceal yourself behind a neutral, non-reactive ‘professional’ facade. If you want to weep; weep. If you want to vomit; vomit. The veterans will regard that as a sign you are listening and that you are hearing what they are saying. Dr. Jonathan Shay Link ~6:20
Hearing this was validating. It helped overcome the hesitancy to be moved deeply by patients. While respecting boundaries I have held many hands and listened to patient’s stories, and I believe they can tell I’m present both intellectually and emotionally. What I’m doing isn’t out of the ordinary, but I’ve had a number of patients thank me and appreciate their stories and concerns being heard. These connections have made clerkship far more rewarding than simply an accumulation of knowledge.