Paternalism and medicine have a storied past that is difficult to grasp in the abstract. For me, the values of autonomy and beneficence were cemented on the day I ran my second marathon.
After the first one, I remember being asked what the hardest part of the race was. “Every mile was harder than the last,” I replied. After that day I felt like I was in the best shape of my life, dampened only by having fallen nine minutes short of my goal. Resilient, I recovered for a week, trained for three and then raced again in the Indianapolis Monument Marathon.
The first 13 miles were great. Then I hit the wall. Suddenly I went from cruising to crawling down the road. As my stride slowed, I was forced to accept that my goal time would remain elusive that day. All that was left to do was finish, and I was weak. I felt like a skeleton running down the road with my muscles stripped bare. My steps were tiny and demanded enormous amounts of energy. I ran 10 consecutive lifetime slowest-miles-ever. Maybe it was because I changed my race-day playlist from hip-hop to indie rock. Or maybe one month was just too soon before running another marathon no matter how fit I felt, but I was having a bad day. I persevered, and the result was excruciating, numbing, scary and enlightening — in that order.
I feebly limped across the finish line. Slowly making my way through the crowd, I was desperate to stop moving. I sat and subsequently laid down on the first place I saw, which I quickly learned to be a cold cement bench. Being off my feet was a relief, but exhaustion, dehydration and that cold cement left me in poor shape. I began to shiver, and each shiver sent an electric shock of muscle spasm through my aching body. Family members were asking if I was in pain, and I thought, “What a stupid question! I’m obviously in a lot of pain, and the effort of speaking will only make it worse. I don’t need to answer that.” The scene was bustling, but also quiet at times.
I was wheeled to the medical tent to warm up. A doctor ordered hot soup, which burnt my mouth but brought relief almost immediately. I stopped shivering, and soon I wanted to get up to walk it off. I was urged to be careful but eventually convinced my mom to help me with my shoes. This was a little bit of an ordeal because I was helplessly stiff, and it took a few minutes. Then I was ready to go.
“Where are my shoes?” I asked.
I looked down. I saw my shoes on my feet and felt a sense of fleeting confusion. I imagined how I would have described a patient in my shoes: distressed and quiet. The words ‘mental status change’ and ‘non-responsive’ sprang to mind. At that moment I was feeling much better, but I also understood why my family did not believe me when I said so. Apparently, I had been telling them I was fine while also talking nonsense.
Looking back, I imagine myself as a future patient I might have. I was mildly delirious and probably not competent to make medical decisions for a brief time. I am fortunate I had people around me to warm me up and coax me to rest for a few extra minutes. I had started to feel better almost as quickly as was the turnaround that had been the wall, but my good judgment might have been slower to return.
As a third-year medical student about to begin clinical rotations, it is easy to be intimidated by the prospect that I will someday likely have to be responsible for taking away someone else’s right to make personal decisions. Realistically, I expect to encounter violence that necessitates restraint, abuse and other vulnerable patients. Having received from family and professionals the benefits of a caring environment, I feel more confident in my ability, in concert with the healthcare system, to make good decisions when faced with difficult questions of autonomy and beneficence. Maybe every doctor should be a patient first.