Compassion vs. Cynicism, the struggle continues...

Three weeks ago, more than thirty medical students, as well as a few physicians (Dr. Andru Ziwasimon, co-writer of this blog, Dr. Lanny Smith of Doctors for Global Health, and even Patch Adams was present for part of the time), got together in beautiful West Virginia for a health justice gathering. The gathering was organized by some kickass medical students.

Issues from keepin' it real in health justice work, to keepin' it compassionate in medical practice were discussed. I wasn't able to make it, but two years ago I participated in a health justice gathering that Andru Ziwasimon organized, in the Jemez Mountains of New Mexico, and I left that weekend completely re-energized. After this recent gathering, one of my friends told me over email: "I guess it's more about loving humanity than getting pissed off by the system that should drive my actions." Word.

Today I came across this week's issue of U.S. News and World Report, which has a feature section called "Who Needs Doctors?" The magazine contains articles and short pieces on physician practices and doc burnout (how many more articles do we need to read about docs moving into cosmetic procedures and lifestyle specialties over primary care?), the nursing shortage, and the turf wars that exist among physicians and allied health professionals (why can't we all get along, man? all this fighting and patients are still waiting months to get treatment). But one piece really grabbed me -- an essay written by Rachel Sobel, a 3rd year medical student, entitled "The Next Generation". It reminded me of the importance of being driven by the love of humanity and counteracting cynicism with compassion. I'm attaching most of the essay below because it's so beautiful:

...this year, my third, has brought a loss of some innocence. As I trained on the hospital wards, I was surrounded by unhappy, jaded residents -- med school graduates doing their first stints as working doctors. These residents were my teachers, and they griped about the "bitchbox" or pager that they had to wear and about bothersome patients, such as "High-Maintenance Mom." Cynicism certainly catches on. I was stunned how quickly I had started to change. Just a few months in, I rejoiced with one young doctor when our frail, demented patient was finally transferred to a nursing home. We celebrated not because we had helped him--though we did, a little--but because we were relieved that he was finally off our hands. Another classmate ruled out a specialty she had long considered, because the patients were too needy. "Too needy?" she said. "I can't believe I am thinking this way, but they were just too draining."

But as much as cynicism is contagious, so are compassion, optimism, and hope. One professor required us to include in our case presentations what our patients like to do for fun. He understood that while wading through a sea of data about a patient, it was easy to dehumanize care. The woman with Marfan syndrome and a serious heart problem, it turns out, had been an avid hoops player. The man with cocaine-induced chest pain--he's a serious stamp collector.

One resident showed me that even while being bogged down with paperwork and beeping pagers, taking a few minutes to do what's not "required" is still possible--and can make a real difference. In the clip of a busy day, he found time to counsel a homeless patient, a former lawyer who was diagnosed with alcohol-induced heart disease, about the very serious cardiac consequences of his addiction. "I always thought alcohol was bad for my liver," the patient said, somewhat surprised. "I didn't know it could damage my heart." The patient was discharged, newly informed and newly hopeful, holding a list of local sobriety programs.

Fellow students have reminded me, as well, that we possess strong medicine--not the drugs we can give to patients but our words, the timbre of our voice, and the touch of our hands. A few months ago my classmate Julie, who was transferring her patient's care to me, brought me to his bedside to introduce us. A pungent sour odor wafted through the air. There was a pink tray by his side to catch his frequent vomiting. The thin, white-bearded patient greeted her like a close relative: "Julie, my darling, I've been waiting for you."

The man, recently diagnosed with end-stage lung cancer, was troubled. His wife had suddenly stopped coming to visit him in the hospital. He worried that she was too scared to see him go, that she could smell the aroma of death in the air. "Do I smell like death, Julie?" he asked, patting his lips after hocking up a small concoction of phlegm and blood. Julie placed her hand on his bony shoulder, bent over toward his straggly beard and took several deep whiffs. "Absolutely not. Don't you worry one more minute about that." He smiled, looking relieved, and then he thanked her. And I smiled too, to thank Julie for helping to restore my faith in this extraordinary relationship.