I had not yet guided a ‘goals of care’ discussion. This is the discussion that entails understanding a patient’s wishes regarding end of life care, and it is often in the context of determining what advanced medical interventions the patient might want. That day, my short white coat felt shorter, like it was yelling out to everyone I encountered that I had no idea what I was doing.
While I knew little about these patients at the beginning of the day, I always started out knowing one very important fact: they were already dead.
They asked me how that encounter had gone, and I could feel my cheeks turn bright red. I was embarrassed that I was not able to connect with my patient.
Drawing from this discussion of humility, one can see that we are not so different from our patients, which may seem obvious but is too often not embraced. We are all limited; that is the natural order of things.
“If I don’t get a cigarette right now, I’m going to punch someone,” he said. “Okay, I understand. One second.”
To keep breathing does not mean to go at it alone or to put up a brave front even when it feels as if the world is collapsing. To keep breathing is to always push towards the goal even when it’s hard and even when it doesn’t feel worth because it will be in the end.
His right leg jittered beneath his orange, prison-issued jumpsuit. The manacles across his wrists rattled with the chain connecting them to the cuffs around his ankles.
Through my patient’s same wants and needs, I saw my own thoughts, feelings, hopes, dreams, fears and my own desire to be liked, to be wanted, to be needed. I felt, for the first time in a very long time, a genuine human connection.
I float in an ocean of sterile cerulean. / In this deep of drapery and gowns, / One could swim out and never see the shore.
My mind kept returning to the patient I had encountered earlier that day. I experienced this subtle feeling that something important had happened. I became curious about the man and his story, but above all, I wondered what the most important part of that appointment had been.
The practice of humanism must be at the core of medicine, and this different model, entitled the biopsychosocial (BPS) model, permits and exemplifies this practice.
The opportunity to be immersed in learning the stories behind the health of patients is one of the things that drew me to medicine, and, indeed, it still intrigues me. More importantly, I was (and still am) intrigued by the opportunity and challenge of using the multiple streams of information patients present with to make functional improvements in their lives.