They say to be a good doctor, you have to leave everything behind when you enter the exam room. You walk in with a clean slate — shiny and sterile, crisp, clean and decontaminated. I wonder if that’s why we wear a white coat? To symbolize the unscathed, untouched and pristine figure who walks into the room and solves all the problems. The one who just woke up from a refreshing nap renewed and restored and ready to hear a patient’s story as if she is hearing it for the very first time. She will write a magical prescription and bestow miraculous healing, then float away until the three-month follow-up visit. It’s almost biblical and holy. But is it realistic? The truth is, when I walk into a patient room I am anything but sterile. Physically and figuratively. I carry the heavy baggage that I picked up in my last patient interaction and the one before that and the one before that. I am stained with the pain and suffering of my patients, and my heart is a little bit broken and bruised each time a patient deteriorates, and there is nothing I can do to fix them. I am exhausted and sometimes dehydrated. I have not urinated in 12 hours (which is the definition of AKI, by the way). I am sleep deprived, and I’m pretty sure the most exercise I have gotten this week was running to the Code Blue last night. Oh, and my white coat? I can roll up my sleeves to hide the coffee and ink stains. But there is nothing I can do about the lurking, invisible MRSA that lives on all my clothes. And yet, we are taught early in our training that to be a good doctor you must make yourself invisible. Your own problems do not exist. Your struggles, your history, your background, your demons don’t matter. This is how you create room to take on medical mysteries and perplexing cases. You are essentially a shell made up of scientific facts, evidence-based guidelines and formulas. And you do not allow your personal beliefs, biases, experiences and “humanness” to interfere with your clinical judgment. You do not get emotional. You maintain healthy boundaries. And whatever you do, do not, under any circumstances become personally attached to your patients. You rid yourself of “you” to become — or “unbecome” — a professional. And you must do this regularly, a “maintenance” if you will, in order to fulfill what is expected. This is devotion. This is empathy. This is good medicine. I think the majority of this “undoing” takes place in residency training. We start as interns with an idea of who we think we are. We worked hard to get here. We have dedicated our entire life to this calling. We feel good about ourselves. And we think we have become who we were meant to be. But what we don’t realize is that everything we thought we understood about the world, and our place in it, is about to be undone. And true metamorphosis is what follows. In residency training, we learn some harsh truths: the brutal hours, sleeplessness, hunger, missing family and friends, loneliness and omnipresent gnawing fear that you will let others down and cause more suffering, levels you to the ground. It unravels and unthreads you. You realize you are not invincible. Your ego turns into dust. Who you thought you were when you started intern year is often not who you really are once the training is over. And I think that is what residency is really meant to do. To make you strong, resilient, and tough. So that when you do walk into the exam room, your sense of self has been replaced with a clean slate. And this is not a bad thing. Don’t get me wrong. I’m all for becoming a warrior. Not many people have what it takes to survive medical training. That’s why we are hand selected from a pool of highly qualified people to embark on this journey. But what about the collateral damage? Do we really want doctors who have been taught to lose their humanity? To dismiss their own needs and neglect their own souls so that they can serve society better? Doctors are, first and foremost, human beings. The good ones, anyway. And it is precisely their humanity, their ability to draw from their own pain and suffering, that makes them good at connecting with and helping others. I heard my favorite author, Marianne Williamson, once say something like, “personal suffering gives you X-ray vision into other people’s pain.” And if you ask me to leave that behind the door and walk in empty-handed, not only am I doing a disservice to my patient, but I am living a lie. So in the nuclear combat that is residency training, where your world is demolished, and you learn to let go of everything, keeping only the essentials, let us keep some of our past experiences and personal struggles as a shrine, a memorial, a holy place of worship, to represent who we really are at our core. Let us hold on to what makes us human and accept and honor our imperfections. Not only in ourselves but in our physician colleagues. Let us acknowledge each other as human beings who have failed over and over again and redeemed themselves over and over again. So that we may be better equipped and prepared to take care of our patients as whole, complete, and intact human doctors. I take a deep breath and put on a smile as I walk into the exam room to greet my patient. He complains of how he is so tired and feels exhausted all the time. He is struggling financially and faces losing his insurance. His wife is about to leave him, and he started drinking again. He is concerned that his teenage daughter is smoking cigarettes and his mother just broke her hip and is in rehab. How can I begin to tell him that on top of all this, his A1c is climbing and his blood pressure is through the roof today. I listen intently as I try to forget that 10 minutes ago I had to tell my last patient that her tumor markers are rising as she continues to lose weight unintentionally. And later on, I am having a heartbreaking goals of care discussion with my dying patient and my pregnant patient can go into labor any minute. Did I leave the stove on this morning? Shoot! It’s my grandmother’s birthday today, and I haven’t called her. I gather my thoughts and focus on my patient in front of me. I am here for him, and he deserves 100 percent of me. But that does not mean that I am not allowed to feel sorrow and heartbreak and excitement and nervousness and anticipation about what has happened prior to this appointment and what is about to come later today. In fact, being sensitive to these feelings is what helps me connect with my patients and empathize on a deeper level. It’s what drives me to give hugs and share smiles and tears and joy throughout the day, and it’s what makes my job unlike any other. As I wrap up this encounter, I hear a knock on my door, “Doctor, your patient is ready in the next room.” Source
