As a medical student in the transition from pre-clinicals to clinicals, I felt incredibly privileged to have the opportunity to interact with patients and finally be a part of the health care team — this is what I came here for. During this transition, I also came to realize that you can look at a patient solely through the lens of a clinician, but doing so will undoubtedly cause you to overlook the human being who is your patient. Clinical medicine is so much more than a textbook coming to life; it is about the fragility of life, the inevitability of death and everything in between.
Shortly after beginning my third year of medical school, I witnessed a code blue that hit close to home. It was a patient with chronic kidney disease who was on hemodialysis — just like my mother. The intensity was palpable as the team rushed to the dialysis unit. Although there were at least 10 people in the room, there was only one who really mattered in that very moment. Of course, as in any life or death situation, the minutes felt like hours. It was loud and chaotic until it became painfully silent — a silence unlike any I had ever encountered. Despite the team’s best efforts, the patient did not make it. The silence lingered for a short while, marking the harrowing realization that the patient was gone forever.
Afterward, the team quickly debriefed. To my surprise, no one showed any emotion. “She was a dialysis patient with end-stage renal disease — it’s not like she was going to live much longer anyway,” said the senior resident. My heart sank. When he looked at this patient, he saw chronic kidney disease and all of its co-morbidities while failing to see that patients are so much more than their constellation of signs and symptoms. However, I saw someone’s parent, spouse, sibling and fellow human being whose life was cut too short. While all he could see was the patient’s clinical morbidities and statistically poor prognosis, I saw a life that lost all its potential in a matter of minutes. I could not help but think of the holidays, birthdays, anniversaries, and family gatherings that would never be the same for a family who lost their loved one too soon.
As intelligent and clinically adept as he was, it was evident that this resident had lost sight of the importance of humanism in medicine. It was then that I knew I had my work cut out for myself. While this simply may have been his coping mechanism, it was certainly not a habit I wanted to pick up. I could not allow myself to minimize the loss of a life, to become so utterly jaded or to let my compassion slip away. While some might argue that becoming desensitized to losing a patient is the only way to cope with repeated losses, such suppression of emotions may be responsible for the staggering burnout and depression rates noted among medical trainees and professionals.
It is both fascinating and terrifying that we can easily lose sight of how compassion is at the very core of what it means to be human — even if just for a split second. Now that I have completed my third year of medical school, I have come to realize that type of morbid sentiment is commonplace in medicine. Sometimes I reflect on that day wondering “what if the outcome had been different?” and how much that would mean to this family; I can almost see an alternate ending without the enduring silence.
While there is no way to choose our patients’ outcomes, we can certainly choose to be empathetic and compassionate regardless of their outcomes. Medicine without empathy and compassion is not medicine at all. I wholeheartedly believe that being an exceptional clinician and a compassionate human being are by no means mutually exclusive — rather, they are inextricably intertwined. If we allow ourselves to feel, to empathize and to mourn our patients, we will undoubtedly be better clinicians. Needless to say, I am committed to coming out on the other end of my medical training just as compassionate, if not more, than when I started this journey for my future patients and for myself. After all, I like myself a whole lot better when I am a little more human.