Louisiana State University Health Sciences Center, New Orleans, United States
As medical students, we are taught the “art of medicine” and the importance of gathering a thorough patient history. “Ninety percent of your diagnosis comes from the history,” we are told. And to do so, we must establish a rapport with our patients. We enter the lives of patients at their most vulnerable moments. We are participants and witnesses to some of their most intimate moments—the birth of a new life, the death of someone who has lived a full life. Through it all we must be good listeners and astute diagnosticians. Above all else, we need to show compassion. We throw around the word compassion a lot, but what exactly does it look like? Let me try and paint a picture for you.
In January of 2012, I shadowed an attending doctor at University Hospital for a week. Beyond teaching me about the role of a hospitalist, this preceptorship experience left an indelible impression upon me. Dr. Angel* walked into the room of one of his patients, Mr. Jones*—a 75-year-old man with advanced lung cancer that had spread to his brain. His brain tumor had responded to radiation and chemotherapy, but now he was back with a giant lump in his throat, impinging on his trachea and esophagus, and preventing him from breathing and eating. Weak and emaciated, he was constantly gasping for air. On this particular visit, Mr. Jones’ extended family was there—his wife, his sister, three of his kids, and four of his grandchildren. Dr. Angel walked in and introduced himself to everyone in the room before sitting down at Mr. Jones' bedside. He explained what the radiologists had seen on Mr. Jones’ neck x-ray, using medical jargon where appropriate—explaining terms like metastasis, and pausing where appropriate to address each family member's questions, concerns, puzzled looks. Mr. Jones’ prognosis was not good and Dr. Angel did not try to sugarcoat this fact. Acknowledging every person in that room, Dr. Angel effortlessly interspersed talk about Mr. Jones' disease progression with lighter banter about basketball, school, and the family’s dinner plans for the night. He exchanged these short pleasantries with the family as though he had been invited to their house for a dinner party.
All this is very far from the image conjured up by a dinner in the warmth of someone’s home: fluorescent lights, a sick loved one wrapped sometimes not so modestly in a hospital gown, too weak to sit up and confined to a hospital gurney that does the sitting up for you. . . this image of the humdrum atmosphere of a cold hospital room seems to douse the warmth we think of when we think of intimate family gatherings. But that warmth and liveliness was exactly how Dr. Angel managed to make this moment feel. And it wasn’t just this once. It was every patient we saw. “Welcome to my house,” he would say to every one of them. “We’ll take good care of you.” Never hurried, always even-keeled, he knew how to address his patients, his residents, interns, and students, the nurses, lab techs, the hospital cleaning staff, and the cafeteria staff. Everyone knew his name, everyone stopped when Dr. Angel walked by to exchange a quick hello, a friendly high-five, an acknowledging smile, regardless of whether they were writing a note, searching for a medical record, or on the phone.
I don’t mean to aggrandize Dr. Angel and yet I am. Society views physicians as heroes. When people are sick, they go to the doctor. We expect miracles from our doctors. This expectation brings with it a lot of pressure but one that doctors spend years training for, to become responsible for the life of another human being and to make difficult decisions that often hinge on life and death. As medical students we are in training to assume this responsibility, and early on in our careers it is easy to feel overwhelmed, especially when face-to-face with patients entrusted into our care. What I have learned from watching Dr. Angel is that the core of medicine lies in our ability to connect with our patients’ suffering—because in doing so, we exercise our compassion for others, acknowledging and understanding their pain as best we can. We are more effective when we treat the whole person and not just the disease. We become better doctors as we develop the compassion, humility, grace, and humor that helps lighten the painful load our patients bring to us.
* Names have been changed to protect the identity of the individuals.
ANNIE YEH is a second year medical student at the Louisiana State University Health Sciences Center in New Orleans, LA. She is interested in international health, development economics, public health and health policy.