A woman once told me that babies cry at the slightest breeze because that is the greatest level of discomfort that they have yet experienced in their short lives.
It is a reminder that we can persevere through life’s tribulations. That we grow from adversity. That new challenges make past trials smaller.
That this, too, shall pass.
I suppose then, it is a testament to our growth that we no longer cry from warm baths, cooing strangers or scratchy socks. It is uplifting to think that wisps of wind, as innocuous as they are today, were once overwhelmingly strange and violent.
My first experience wearing my short white coat began in a conference room filled with hospitalists awaiting a Morbidity and Mortality discussion. As a first year medical student, I have not yet become accustomed to the white coat perched atop my shoulders or hooked over my arm. It is still a costume I am scared to don, a pair of big-girl shoes I do not yet feel I can fill — a uniform with too great an authority. My short coat is starchy from inexperience, weighed down by patient checklists, first year flashcards and insecurity. The stethoscope still feels foreign, another accessory that finishes an unwitting costume. I have not grown accustomed to these things, but perhaps with time I will wear them with greater and greater ease until they, like the wind, become nothing but a second thought.
The session opens with a clear objective: “How to understand medico-legal aspects of discharge process and physician liability” — a case study discussing the procedural complications in patients who seek discharge against medical advice. The presenter flows efficiently through the patient history, tongue sliding effortlessly across terms like “ascites,” “hematochezia,” “hematemesis” and “dyspneic,” which are still bulky and encumbered in my mouth and mind. She swiftly recounts the case history of her patient, running through her symptoms, lab results and treatment plan. I am forcibly reminded of how new I am to this journey. The inadequacy creeps.
The conversation shifts to the difficulties of discharge against medical advice, the complicated balance between patient autonomy and physician responsibility. Guiding the conversation is the story of a 59-year-old woman, an anonymous placeholder used to invite the scrutiny and education of physicians. She is a cardboard cutout, a hypothetical patient who left the hospital against recommendation, only to be found unconscious several hours later by her son.
“Time of death 3:25 p.m. called by ED attending.”
Stop.
I scramble to flip the presenter’s handout back, back, back. There, several slides previous, is a simple chart annotation that suddenly washes other thoughts away.
“Patient wants to go home, her daughter is getting married tomorrow, anxious to leave immediately.”
Stop.
My care for the current discussion on discharge procedure and protection against legal retribution is obliterated.
“Time of death 3:25 p.m. called by ED attending.”
This woman died on her daughter’s wedding day.
My mind is assaulted with pictures of someone else’s nightmare. I see a nameless bride wearing a crumpled expression and a pristine silk wedding gown shouting after a retreating gurney, a fiancé thrust too soon into his beloved’s unending pain, a harbor of bridesmaids sobbing into bouquets meant to predict a happy future. I think of the confusion. The panic. The heartbreak. The grief.
How did they tell her?
Stop.
Nobody stops.
There is no change to the pace of the presentation. No hiccup in delivery. It continues with a perfect academic examination on the technical difference between “competence” and “decision-making capacity” — a utilitarian departure into semantics amidst a story of a broken family. I have no poeticism to describe this. I am drowning in unforgiving waters yet the conversation stays still and smooth. I am unsure if practice has made these physicians impervious to these assaulting emotions, or if they are merely better at tempering themselves. They pick at their fingernails, refresh their email, check their pagers. Those who remain rapt stay baited with the promise of legal navigation, while I stand trapped by a net of growing distress. Sorrow blooms in the back of my eyes.
This woman died on her daughter’s wedding day.
Can you imagine?
Stop.
The idea that many of our most poignant discomforts will one day become peripheral events of the past has given me comfort as I move through life. The obstacles that seemed so insurmountable are now life experiences that I met and passed along the way. The exams that felt impossible, the lover who caused calamity, the rejection letters bearing crushed dreams — these are challenges that felt overwhelming at a time when we didn’t have the skills, maturity, and foresight we have now. It is easy to look back and chuckle at how heavy we thought our burdens were. The idea that discomfort is oftentimes temporary and fleeting has always tempered my worry in the past.
But this is different. Far from comfort, the idea that this career will desensitize me to grief and illness and death and dying terrifies me. The loss of others has always been sharp and acute to my being — I daresay it is one of the reasons why I sought to enter the medical profession.
As we surround ourselves with disease and loss, is it inexplicable that we lose our natural reactions to the grief of others? Do we expand our boundaries of discomfort so far that what was once devastating to hear or to tell will become nothing but routine?
Is this what I am supposed to want?
This idea of babies and breezes is a reminder that experience is life’s greatest teacher. That experience will tell you what is worth your tears. Your hurt. Your care.
There is a classmate in my small discussion group who has told me “this whole physician sensitivity thing is way overdone.” He says it is not only unnecessary, but in fact potentially harmful. But I think there is a difference between being sensitive and being emotional — between feeling sorrow for a patient and being consumed by it. Yes, the distinction is difficult, but whoever said medicine was easy?
I find value in my grief for others. In a world filled with injustice and ugliness among its beauty and wonder, it is empathy that allows us to connect. While I cannot say whether this empathy is definitively a strength or weakness, it is, wholeheartedly, a part of my individual being that I treasure. And whether it is a product of desensitization or merely a mechanism of survival, I do not want grief to be just
a breeze.
Writer-in-Training and in-Training Staff Member
Warren Alpert Medical School of Brown University
The white coat is a scary, scary thing, and I'm still trying to figure out if I should have one. If you like screaming about ethnic rage, dance, or the woes of medical education, we should probably do some of those fun activities that friends do.
I have few answers, many questions. Dialogue is huge. Feel free to email with questions and comments!
