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.
Seems like it was New Years a second ago and now February is ending. This marks the halfway point of our clerkship training; hard to believe. Internal Medicine is out of the way and Family Medicine starts on Monday.
My IM rotation ended with strong feedback from the attending. A nice way to end a block. I’m sure I’ll feel somewhat lost for the first few days of the next one: learning the EMR, way they enter orders/present cases, etc. Good to end a block on a positive note to transition into new territory.
IM ended with six weeks of CTU. This was split between an adult in-patient unit and one focusing on those over 75 years-old. It was nice to see care in the adult and elderly population and learn to deal with different issues, from endocarditis and liver cirrhosis to CHF and palliation for metastatic cancer. It was quite a range and required a good deal of study/review at home. This was also the first rotation where we were given responsibility for everyone on the floor when on call. During pediatrics a resident was always present to cover floor issues, here we did consults in the ER and covered the floor. Terrifying the first couple call shifts, especially since we can’t order anything. A combination of responsibility and powerlessness that can be quite unnerving. Over time I learned to prioritize, which questions to ask when paged and paired up with one of the residents to co-sign orders. Very stressful, but I also learned a lot.
Off to a rural family medicine placement tomorrow. Going to be quite a change. I’m hoping the experience in IM gives a good foundation for it. Working with 4 different doctors in a group clinic, will be a change. Family Medicine is an option I’m considering for residency, so the next few weeks should aid in that decision.
Just a silly observation, but after two weeks in the outpatient clinic the majority of pregnant ladies we saw are waxing their bellies, and seem to be doing so to coincide with their appointments. Uh, thanks I guess…
The next two weeks are on delivery service, first week nights, second week days. Will be an adjustment from seeing OB/Gyn patients in clinic.
At the end of my first year of medical school I spent a few days shadowing Dr. S in a small rural hospital. He was one of the younger doctors in the hospital, spending time in both a family medicine practice and in the emergency department. We had many similarities; both of us studied microbiology before entering medicine and recently started families. We bonded through these commonalities, leading to my being granted some independence in seeing patients and taking histories. Between patients he stood in the office, gently swaying back and forth, sharing with me his love of medicine.
During one short break, he proudly shared a few pictures of his infant daughter. He mentioned that he had recently dropped his workload from 115 hours a week to 65, with further reductions planned. I was surprised that he had such a workload until recently and proceeded to ask what had led to the change.
“A colleague of mine, also working over 100 hours a week, came into work crying one morning,” Dr. S stated. “When I asked him why he was crying, he said that that morning his 4 year old daughter had approached him and asked, ‘Daddy, where do you live?’” I could see that just telling the story caused him to well up. He blinked away a few tears. I gave an understanding nod. Nothing more was said on it, and we went on to see the next patient.
Originally published in the UNM Medical MUSE Spring 2014 Edition. Available online PDF