Beyond medicine

Jessica A. Tang
Chicago, IL (Spring 2017)

 

Surgeons in action

I remember staring intently at the doctor as he presented two options: surgery or do nothing. Surgery could not promise drastic improvement and even came with the risk of paralysis or death. Doing nothing meant an ominous future of moving onward until something traumatic occurred. Neither choice sounded desirable. Was there not a better solution?

I was shadowing the surgeon as he made his rounds in clinic. The patient was an older gentleman who had developed a metastatic tumor that had spread to his spine. His wife kept repeating to us, almost pleading with us to agree with her, that she did not understand how her husband, who had always been healthy, could wind up in this dilemma. But the surgeon left the decision to them. As we left the room, he whispered to me, “They don’t seem to believe it, but he doesn’t have much longer.”

As I went back to clinic week after week, I noticed a pattern. The surgeon would present the facts to the patients and let them make their own choice. Surgery was not a fix to their ailments, only a temporary relief, a postponement of the inevitable. In that way, treatment was guided chiefly by their own expectations; the decision relied on their own assessment of the benefits and risks to their preferred lifestyle.

Even then, there would sometimes be no explanation for their symptoms. More frequently than I expected, I saw patients complain of pain, yet their x-rays and MRIs revealed no evidence of abnormalities. It did not take long for me to learn that medicine is very much a profession of uncertainty and mystery. Each patient’s situation is a puzzle to unravel, a collection of symptoms to identify and diagnose. And doctors, with the expertise gleaned from medical school, residency, and years in practice, still encounter phenomena they cannot explain or offer favorable solutions for.

My view of treating patients did not begin this way – I was naïve enough to believe that doctors had all the answers. It was with an innocent fascination that I initially surveyed the medical field. I volunteered at local hospitals and ventured into the Emergency Department. Amidst the chaos of suturing lacerations and reducing fractures, I began to recognize the value of personal connection with patients. I caught glimpses of their stories and backgrounds and saw that they needed dignity and respect just as much as they needed physical healing. They were appreciative when doctors, in small tacit ways, reassured them that they were more than just someone’s mission to accomplish, more than another opportunity to play hero and victim.

Fast forward several years and I find this perspective becomes more tangible and provokingly personal in my daily practice. Indeed, my most memorable moments in the hospital wing are not those interesting surgeries or perplexing cases, but the hundreds of stories behind faces of people in distress or relief, alone or with family, crying tears of joy or tears of sorrow. I am reminded that that we doctors are still human. I may not be able to fully remove the tumor, to prevent the disease from returning, or even 100% accurately diagnose the mystery of puzzling symptoms. But it is such a privilege to be able to participate in one of the most meaningful times of a patient’s life. There is nothing more human than coming to terms with our own fragility as human beings. It is in these moments that I can witness the extremes of beauty and strength people are capable of in life-changing circumstances, or even the heartfelt depths of despair when grasping one’s own mortality. Some battle their disease surrounded by family and loved ones, others suffer all alone in their hospital room. Some leave this world reflecting on a fulfilling life, some die filled with regrets. What an honor to share such a sacred space with another human being.

The realization was not one discovered overnight, nor was it at all forthright. Admittedly, it involved countless moments of presumption and, might I say, arrogance on my part before I began to see medicine as more than a fulfilling profession, and see patients as real, hurting people. The more I heard their stories, the more those one-liners and medical jargon we use to describe patients became individuals with names, narratives, families, and desires similar to mine. The 32-year-old male with a past medical history of repeat methamphetamine abuse and leaving rehab multiple times against medical advice became Joe, the young man with a rough exterior but soft heart who longed for the companionship that some of his fellow rehab partners had with their families. He was brash and rude in his initial entrance interview, but I saw the pain in his eyes as he later confided his deep-seated anguish over the fractured relationship with his family that his addiction cost him. Then there was Catherine, a well-dressed, professional young woman whose story of childhood mental, physical, and sexual abuse was so severe she could only remember events in sudden, unexpected, and debilitating flashbacks. I remember Rudy, a gregarious man with a wife and two young kids, who later committed suicide in the hospital ward. Danny, the confident 28-year-old ex-Navy Seal, had a vulnerability to him, and I saw how his normally poised conduct eroded at the thought of making his sexual orientation known. I had judged each of these patients immediately and subconsciously, based on clues from outward appearance and demeanor. But each patient’s story transformed them from just another nameless face into someone’s parent, child, sibling, partner. Proximity changes everything. Proximity forces you to stop compartmentalizing people into categories. Proximity makes you confront your prejudices. Proximity makes patients people.

I am young in my career, I know. I have more years to become jaded by the flaws of our medical system and the difficult patients who refuse to treat us with respect, or to become cynical from the morbidity of hopeless situations and poor results despite our best efforts. Truth be told, I think part of me has already started that process. I have to fight against my natural tendency to frame patients into “pleasant” and “difficult” boxes and to dismiss each poor outcome as a failure – it is a task that requires constant awareness and introspection amidst a hectic schedule.

But with just a small tweak in perspective, every battle is a victory if only I remember that success is not necessarily measured by satisfactory results and pleasant patient interactions, but by connecting and making meaningful contact with another human being in a desperate situation.

Now I walk into the doctor’s office, as a provider rather than an observer, and I realize it is not just the relational aspect of medicine that captivates me, but even more so, the humanness of the profession – the entirety, from being challenged by the unknown, to learning to deal with the nuances of communicating with difficult patients, and even to constantly remembering that medicine is much more than the business of treating patients as a venue to practice altruism. It is the opportunity to see a fellow human in a new light, and to care for and serve them with my own limited means.

 


 

JESSICA TANG is daughter to a professor whose dedication to her children overflows to her students and co-workers, younger sister to a guy whose hunger for learning extends far beyond the boundaries of education and career, older sister to a free-spirit who yearns to find herself in communities around the world, and partner to a fiercely passionate neurosurgery resident. Originally an engineer, she found the unpredictability of people more appealing than the logical, orderly nature of engineering and pursued medicine to discover the intricacies of being human in some of the most intimately sacred spaces between patient and doctor.