Central to my decision to go into medicine was an observation that physicians have a unique opportunity to build profound connections allowing for long-term personal satisfaction. Eager to learn medicine and experience the gratification of caring for people, reality set in not long after starting medical school in 2020, when I discovered the topic of physician burn-out. According to the American Medical Association, physician burnout is a “long-term stress reaction which can include…emotional exhaustion, depersonalization (i.e. a lack of empathy for or negative attitudes towards patients) [and a] feeling of decreased personal achievement.” Despite increased awareness in recent years, physician burnout remains unabated, its weight unyielding in an overburdened healthcare system. Reflecting on my cumulative clinical experiences and observations in medical school, I posit that our best protection against burnout is a professional identity rooted in our shared humanity with others.
One experience that helped me understand what it means to enter into the profession of medicine occurred during my third-year surgery clerkship while on the trauma service. I was in the middle of a 14-hour shift on my last rotation of an exhausting third year when my team received an alert for an elderly man with a serious fall-related head injury. Shortly after the patient’s arrival, roughly a dozen of his family members, several speaking only Spanish, arrived in the emergency department. Overhearing a request for help communicating with the family, I left the busy trauma bay to see how I could help gain details about the accident.
Arriving at the waiting area, I suddenly realized that I was the initial messenger for this family spanning three generations, including his understandably distraught wife, Rosa. In that instant, I recalled witnessing the inconsolable heartbreak of my own grandmother at my grandfather’s funeral years earlier. With this on my mind, I sat with Rosa and took in the strength of her grip, the desperation in her tear-filled eyes and her plea to save her husband’s life. As if speaking in Spanish to my own grandmother, I expressed my condolences for what she and her family were going through. When I followed up our conversation by offering a hug, I felt the full release of her sorrow in our embrace. It was as if recognition of her heartbreak gave her permission to express her devastation and fear in a moment of sudden tragedy.
Initially, my decision to spend time with our patient’s family was based on a realization that there was little more I could offer in the chaotic trauma bay. However, witnessing firsthand how many people were profoundly impacted by this situation presented to me a clear need for some kind of presence. I may not have provided the family the answers or assurance they needed, but I was struck by their appreciation for a medical student with a limited ability to provide clarity in that moment. After offering what little comfort I could, I started to make my way back to the trauma bay, assuring that a physician would follow up with more specifics soon. But before I could leave, one of the younger grandchildren approached me. With outstretched hands and an innocent smile, he proudly presented me with two quarters in gratitude. Taken aback, I expressed appreciation for his gesture and explained that our commitment to caring for his beloved grandfather was our job. Hearing the rest of the family laugh in the background while observing our interaction, I felt the collective awe of an unexpected purity amidst tragedy in this child’s kindness and grace.
The moments following my interaction with this family felt surreal. I knew I hadn’t done anything to improve the outcome for our patient, so had I done my job? Would I have been of more direct use to my team elsewhere? In truth, I was not thinking much about my role after arriving to speak with the family. The scene of their confusion and grief struck me so viscerally that I did not think twice about approaching them, with memories of my grandfather’s passing flooding my mind. I knew I would not be able to provide satisfactory answers to the inevitable questions they would have about how serious our patient’s injury was. I did know they were anxiously awaiting communication from anyone involved in his care, so I did my best to provide early updates without preemptively sharing the expected poor prognosis for their loved one.
This experience gave me plenty to reflect on. Should I have been more detached, more “professional” and objective in how I interacted with this family? Should I have been more upfront about the gravity of our patient’s condition? Did I offer too much of myself in sitting with them, nearly being brought to tears myself? Undoubtedly, these are the types of questions many of us ask ourselves throughout training during and after high-stakes encounters. I acted unsupervised in this encounter, so I had no real opportunity for direct feedback from senior staff on how I handled my approach with this family. That said, the sincere expression of this family’s gratitude was all the feedback I really needed. I made myself vulnerable going into an emotional situation under no supervision and I let my intuition guide me.
The personal impact this experience had on me was a poignant reminder of not only “why” we practice medicine but also how we transcend the roles of mere practitioners by embracing our shared humanity to become advocates, confidants and sources of solace for those navigating tragedy. At the time of this experience, I was feeling burnt out having started over with yet another new team in another new specialty as was the case every five weeks for the prior ten months throughout clerkships. By the end of my first full year of clinical rotations, I was overcome by a strange mixture of powerlessness, humility and gratitude to be on a professional journey that privileges me with the trust and confidence of others in their darkest moments. The nature of the challenges we face in medicine vary widely and demand continued growth and reflection in order to prevent burnout. In my experience, embracing my own vulnerabilities in connecting with others has allowed me to develop a unique professional identity welcoming of my own humanity.
Honoring the connections we form with our patients, their families and our colleagues helps cultivate a resilience capable of withstanding the relentless forces that would otherwise burn us out over time. Not only does this make us better at our jobs, but it also provides us with significance and purpose by being part of something larger than ourselves. For this reason, I look ahead to the next set of challenges in training as further opportunities to become professionally human, ever receptive to the life lessons that await.
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Artist’s Statement
At the conclusion of my third year of medical school and during my fourth-year rotations, I journaled about impactful clinical encounters I have experienced and reflected on these moments as I prepared my application for residency. This piece was written in June 2023 using Microsoft Word. I wrote it initially as an affirming reminder to myself for why I decided to pursue medicine in the first place and to help bring clarity to the type of physician I hope to become. During the writing process, I felt it was worth sharing this piece as an invitation for others to self-reflect on what keeps them resilient throughout medical training, particularly with regard to how we connect with others. This is what has kept me grounded amid the chaos and stress of medical school. I have been told by some attendings I have worked under that residency will force me to concede to becoming less empathetic in order to keep up with high patient volumes and an unforgiving work life. This inspired me to prove to myself I can still be the physician I imagined myself becoming when I began medical school. We all can. I hope to communicate through this piece that humbly embracing our shared humanity with others allows us to grow and serve the endlessly diverse people we encounter throughout our careers in medicine.
Confidentiality Attestation
The name “Rosa” in this narrative is fictional. Small details regarding specifics of the patient and their family were altered so as to protect patient confidentiality.
Image Credit: "dirty money" (CC BY-NC-ND 2.0) by .sanden.
