There is nothing normal about being a physician, or training to become one.
On the second day of medical school, I cut open a dead man’s body. Soon thereafter, I found myself in the lab many times over, pulling various body parts out of drawers and staring at them for hours. Alone. Sometimes until midnight.
I have stood in a trauma operating room, wearing a gown splattered with a dying person’s blood. I have seen, heard, and smelled things I never thought could come from the human body. I have stuck tubes and needles into other people’s flesh. I have put a gloved finger into someone else’s rectum more times than I care to count.
It’s just. Not. Normal.
It’s horrendous, grotesque—plain weird, some of the stuff we do. But it’s all in the noble name of medicine, of saving lives, of healing. I know that. We all know that. We even think it sounds heroic. So to soften the somewhat uncouth nature of what we do, we give procedures benign names and talk about them gently, as if doing so could somehow preserve the dignity of the human beings involved. We kindly write on the chart “Below the Knee Amputation,” and we gently explain that we will be doing a “simple procedure” to remove your cyst.
And yet once in a while, I just want to scream: “It’s NOT OKAY! It’s NOT NORMAL! There is NOTHING NORMAL about SAWING OFF a poor old woman’s leg!” It’s like something inside of me cries out just for us to call it what it is, and to quit tiptoeing around, pretending that what we do is dignified.
Before I entered medicine, I always knew I wanted to heal my patients compassionately by listening, holding their hands, and being present with them. But what I did not understand was how I would learn to steward medicine by healing patients and myself through some less-than-likely moments.
I was wheeling Mrs. N into the operating room. She was a sweet, middle-aged woman with a husband and three kids. The anesthesiology team and I worked together to be compassionate and kind as we prepped her for surgery.
Though things were chaotic the moment we burst into the OR and were greeted by a barrage of shiny machines and people, we all set swiftly into motion. As we did, we paid attention to Mrs. N’s comfort as best we could. My resident smiled as he told her about his own kids. The nurses thoughtfully brought her a pillow. I held her hand as the arterial line was being placed.
“Y’all are so sweet,” she said with a tinge of Southern drawl.
I smiled at her through my surgical mask as I gave her oxygen. Soon, Mrs. N was asleep. As the resident began to place her central line, I walked around the monitors, tucked in her blanket, and adjusted the sock on her left foot that had gotten twisted around in the pre-surgery shuffle.
As I gave her foot a reassuring pat, I caught myself thinking, “What? You’re ridiculous, Carmelle. She’s asleep. She can’t tell that it’s cold and she’s not awake to be annoyed that her sock is on funny.” For a moment I felt foolish. I mean, really?
My resident looked at me and raised an eyebrow. I shrugged.
In a few moments, a surgeon would be cracking open Mrs. N’s chest. Then we would put her heart on bypass. Then her entire aortic valve would be replaced. A turned-around sock hardly seemed like a big deal. Plus, the groggy and awful dry-heaving that would precede her extubation, and the pain from having her insides all cut, moved around, and put back together would surely distract her from the ugly yellow hospital socks. And I was right. Later when I saw Mrs. N post-op, I wasn’t even sure if she was wearing socks.
I pondered about Mrs. N and her socks on the way home that day. It reminded me of my first day of anatomy. Before we were about to unzip the bag and remove our cadaver, I made all my teammates stop and just breathe for a moment. I wasn’t really sure why—again, what does it matter, right? The man was already dead and his body had been in formaldehyde for months.
But I realized it did matter. I understand now that my humanity is why I do these things. It is not for the dead man, for Mrs. N, or for anyone else. It is for me. And because it matters to me, in some roundabout way, it matters to Mrs. N, and to all my patients. Because in medicine I am meant not only to heal, but also to be healed.
And that, I have found, is what it truly means be a steward. It is to invest in my patients by being humbled enough to recognize that they offer me something too. As much as medicine gives physical healing, and the holding of hands and compassionate silence give emotional healing, it is part of my own healing to maintain that same humanity in the moments that patients neither see nor experience.
I am not any less broken just because I know more about the human body. Just because my normal involves everything that most people think is crazy or disgusting does not mean that I am any different. I also don’t like being cold. I don’t like wearing my socks backwards. I am scared of foreign situations. I am in need of healing.
And so if reminding myself that what seems cruel and abnormal is still compassionate means that I will kindly refer to sawing someone’s leg off as a “below the knee amputation” or tuck in the blankets on a sleeping patient, damn right I’m going to do it. There is no way we can steward medicine if we cannot allow ourselves to be healed, too. Yellow hospital socks and all.
The Arnold P. Gold Foundation Humanism in Medicine Essay Contest
The Arnold P. Gold Foundation was founded in 1988 with the mission of maintaining the balance between medical science and human needs by ensuring that doctors value and provide patient-centered care that is both compassionate and cutting edge. The Gold Foundation’s annual Humanism in Medicine Essay Contest was launched in 1999 in order to allow medical students to reflect on their experiences through writing.
In 2012, participants were asked to reflect on the words of the Foundation’s founder, Dr. Arnold P. Gold: “You are now a steward of medicine and it is your job to safeguard the profession” What does it mean to you (and your patients) to be a steward of medicine? More than 200 students submitted essays which were reviewed by a distinguished panel of judges ranging from esteemed medical professionals to authors in the field of humanistic medical care.
The top three essays were selected along with ten honorable mentions. Winning essays were published on The Arnold P. Gold Foundation website (www.humanism-in-medicine.org) and will be published in consecutive Fall issues of Academic Medicine.