by Sarah Nossov
This was the moment. This was the instant in which I should feel connected to my patient. This was supposed to be the magic spoke of in medical school fairy tales – the time when you cross over your role on one side of the fence as an observer and realize that you are truly experiencing something with your patient. But instead I am distinctly aware that I cannot be as open to it as I want to be and that as much as I try, I cannot really know what he is feeling. I am then like a voyeur to his pain, and there is guilt as I suppress the excitement I have in assisting in the procedure.
The man whose hand I am holding is crying. I put my hand on his huge head and pet him gently.
“Don’t worry, I know this is scary,” I say.
We were trying very hard to get an IV in his neck and it didn’t work and so now were need to put in a central line bedside. There was a sense of urgency in his hospital room that was obvious. He had been fighting to breathe for days and had a tumor of an unknown type wiggling up from his kidney to his heart that might be killing him. It is one of those situations that even as a medical student you understand the weight of his illness. He could tank at any moment.
His fear rises as our frustration settles heavy in the room filling the gaps between the alarms beeping in the distance in the ICU.
I say “…it’s OK to cry…,” as my resident leaves the room briskly to get some supplies, and some frustration that was floating around follows him out the door like perfume.
I know you are tired. I know you are scared. I know what being tired and scared feels like even though I must humble myself to your horrible illness. You used to be a football player, big and strong, now you lie gasping for air, and we are not exactly sure why. How can you stand to let us take care of you? I think this to myself.
He squeezes my hand as if he trusts me and I feel like a liar. How could he feel comfort in my presence? Can I be making the scene more bearable? Nothing in seeing this strong man suffer that makes me feel good. Perhaps ironically, it is so hard because I so vividly understand how it feels to be so scared. And I worry that if we get too close, he may pick up my lack of confidence that we can save him.
It feels like the cool water aquifers under the Pine Barrens on Long Island where I grew up. I know they exist because my teacher told me so. That was the time in my life when I was making dioramas of Iroqouis longhouses in elementary school. Pristine and hidden waters live deep underground, filtered by the sand and the roots of the trees that even the natives knew about, long before we converted their potato farms into strip malls. Right now in the ICU I am tapping those hidden lakes underground, and a little well of emotional stirring comes to the surface at this mans side. In the face of his fear I need to be strong, and hold it back. Because if I were to cry, would I be crying for him, or me? This is not a time to be selfish.
But I can’t help but be reminded - the impossible has happened to me, too. When I traveled to volunteer abroad between my first and second years of medical school, I was randomly kidnapped at gunpoint off the streets. The two men that captured me raped and robbed me. I handled it. I got medically treated, I went back to school, I testified, and then I won the case with bad guys in jail for a half a century. It was front page news there, but it is something you keep a little bit more secret in life here, in the real life.
I am a survivor in progress, and I see it as an illness, having to face the possibility of death head on, and then again and again, afraid for so long they may have given me a disease that could kill me. So I really know what fear-for-your-life feels like.
The timing of my illness is intertwined so closely with my medical schooling that it is hard to separate. It was during a medical school class, it interfered with my plans, and now it is a part of me. I am learning how to heal others as I am trying to learn how to heal myself, and I cannot help but have trouble dividing those tasks. Do I use it or get over it?
I wish to make my patients feel that they are not alone. My own battle was fraught with isolation, and feeling alone and scared is harder than when holding someone’s, anyone’s hand. But life is so complex. In my experience, I found that some of my closest friends had distanced themselves from me, and I the sad reason why – they themselves had been victims. My pain was too close for comfort, and they understood too much. They could not control the output from the little well, their pain might swell up and stain the sky like a geyser and block the light from the sun. Can I connect with my patients enough to see a need to be fulfilled while protecting myself?
Another patient on my service had a pseudonym “Jane” for her own protection. I would visit her every morning. Even when she couldn’t talk I knew what she felt. She was what could have happened to me had the men pulled the trigger held to my head. A man was mad at her and thought she was cheating on him and had shot her several times in her head and in her chest and then kidnapped their children. She had the most beautiful long dark hair, caramel skin, and delicate brown eyes that turned up just slightly at the far edges. She was very calm. I understood. I could see in her face that I had been there.
I knew before she said it that she was going to make up a real good reason to take it. To make excuses. To feel responsible, because for some reason, our society doesn’t make it entirely clear that hurting someone is not right and that the burden is on the victims to put things back together what was broken. The burden is on the sick to heal. And when sick might seem unfair we look for reasons to make it right, because wrong does not compute. We don’t really want to be on the wrong side or in pain. Pain feels wrong. We like it to go away. We would like to put a cap on that well and call it dry and cured.
It almost felt wrong to cross over to her side, to tell her honestly what would likely happen next, that things would be bad for a while and then get better slowly. That you cannot ignore that it hurts, and that if you have to face the reality that yes, this was happening. But like everything else, the memories will fade enough so that you can get better. Our bodies can be smarter than ourselves if we are lucky.
Boldly correcting her was almost out of line. I told her that there is no excuse that makes what happened to her right and even though she was in pain doesn’t mean she is being punished for something she did wrong. I felt she had a reason to be mad, but I knew it would take her a while to realize she was entitled to that feeling. And I got the cover on my well just a little late that time… and it was hard not to cry for her, for me, for all my girlfriends. As imperfect as my advice may have been, I was there and I could relate and she was not alone.
Struggling with insecurity about my ability to be an objective caretaker of people who are sick might be part and parcel of being in clerkships. It is hard to devise a mechanism to dispense little personal pieces of myself to my patient, in order to use that connection to best communicate. When Jane was leaving I was certain I had gone too far and made it too personal, but she thanked me and affirmed I was the only one who understood. She wanted to keep in contact with me so that I could talk to her more, as things changed.
It was a hard decision. It would be so much easier to chalk it up as inappropriate for some reason. I wasn’t really a doctor yet. I liked it when I could be contained. But I agreed to continue to support her. Connecting with Jane required the ability to acknowledge the hard things that I know academically and personally and use it then to help her travel a path slightly less painful.
I see that what I was doing for Jane I learned from my own doctor, the one that flew to Central America to testify on my behalf. The one who meets for Indian food every so often and reassures me, yes, that everything will be fine. She is the one I call my best-doctor-ever. She faces my problems with me and in a remarkably complete way. If I can do for my patients what she has done for me, then perhaps I can learn everything else it takes.
So just for now then, before I master the elegance of doctoring, maybe it is only important to hold the hand, and look into eyes, and believe somehow people can heal themselves. After we leave the hospital room, when the patient goes home, it goes on. It is then that the sick person that has to do the work. We will not be there then, only their belief in our caring will.