2013 Humanism in Medicine Essay Contest: Second Place: Caregiving as Good Doctoring

Duong, David B.

doi: 10.1097/ACM.0b013e3182a89d02
Gold Foundation Essay

Mr. Duong is a third-year student, Harvard Medical School, Boston, Massachusetts; e-mail: david_duong@hms.harvard.edu.

Article Outline

“Hello, my name is David. I am the medical student taking care of your father, and I will also help to translate this meeting today.”

We are in a windowless room, seated around a wooden table, and there are eight concerned, tearful, frightened faces following my every move.

Next to me, my confident and composed attending guides this family meeting—this “goals of care” meeting, this “end-of-life” meeting. In my role as interpreter, I try to find the most delicate Vietnamese words to convey his exact meaning from English.

I am a medical student thrust into the role of the Vietnamese translator and guide as this family encounters and enters a complex medical system. I translate as my attending updates Mr. N’s family on his healing progress from an emergency surgery for a bowel perforation two nights before. In Vietnamese, I ask the family about DNR and DNI status. I hand out Vietnamese language information sheets on hospice and palliative care as my attending talks the family through the options of a Stage IV colorectal cancer prognosis in their malnourished 83-year-old father.

I met Mr. N and his family four days prior when he was admitted to my service with a chief complaint of six months of constipation. It felt like fate that I spoke Vietnamese when Mr. N and his family were only Vietnamese speaking: Of all of the medicine services to be admitted to, he was admitted to mine. So began my medical journey with Mr. N and his family. I woke up Mr. N every morning on my rounds, asking him about belly pain, tapping on his distended abdomen, analyzing his vitals. I accompanied him to get images of his distended belly. I sat with him during his first colonoscopy. I was there in the recovery bay when his bowel perforated, and I rushed back with him to emergency surgery in the middle of the night.

The fact that neither the patient nor his family spoke fluent English or understood the U.S. medical system necessitated that I assume the role of medical navigator and translator. It allowed me to spend more time at the bedside in order to ensure that they understood what was going on. Through this experience, I learned the art of delivering care to Mr. N and his family.

As medical caregivers, we walk with our patients through the complexities of our medical system. We are interpreters of medical jargon. We are bridges from the biochemical processes, the rapidly dividing cancer cells, the attacks of the viruses, bacteria, and the body’s own immune system to the person and family to whom this is happening. We are the deliverers of good news for a cure, somber news of terminal disease, hopeful news of treatments on the horizon, and the assurance of a death with dignity and respect.

In this intimate role as a caregiver, I am reminded of a phrase in Vietnamese that people offer each other at grave moments, when life seems beyond our control, when long-fought battles are lost, or when death takes its final grip: “chia bu

n” or “share in the sorrow.” The phrase means that we share in the emotions, the experiences, the bullets that life fires at each of us. The phrase, gently intoned, is intended to ease the burden, to say, “I am here and will walk with you and yours through this journey.”

The medical anthropologist Arthur Kleinman writes of the East Asian belief that we are not born fully human but, rather, only become human in our interactions with others: through our relationships with others, through our shared experiences with one another, by lifting the burden, sharing the weight, or bearing together the raw human emotions that remind us how little in life is within our control. It is these encounters and this sharing that contribute to, and make up, our humanity. Through these experiences, we open ourselves to the mortality, the fragility, the strength, and the awe-inspiring elements of what makes us human—we open ourselves to our own humanity.

What an honor, a privilege, and at times a burden, it is to undertake a profession that constantly invites us to engage and intersect with humanity at its most fragile moments. Therefore, it is our privilege and responsibility as good doctors and medical caregivers—along with our colleagues in social work, chaplaincy, and nursing, among many others—to strive to deliver the best care to our patients. In Dr. Francis Peabody’s statement to the 1925 graduating Harvard Medical School Class, he averred that “the secret of care for the patient is in caring for the patient,” which resonates with our 21st-century mainstream society rhetoric of the “patient-centered” approach. It is not surprising, then, that the highest ideals in medicine have remained constant.

Three weeks after Mr. N’s emergency abdominal surgery and the end-of-life family meeting, I sit with Mr. N before he is discharged from the hospital. “You have been through a lot,” I say, “it is a miracle you are leaving the hospital.” Mr. N nods, and then his family descend upon us, and Mr. N is placed on a wheelchair to go home with palliative services. As a final goodbye, I reach out my hand to shake his and wish him continued health and strength. He grabs my hand and tells me, “Thank you for helping me not be afraid.”

Throughout my third year of medical school, I have realized that there is no medicine to alleviate fear—the fear of illness, the fear of your body in someone else’s hands, or the fear of dying. But I have also learned that by caring for the patient, by placing the patient at the center of our medical practice, we can establish a trust relationship that just might lessen that fear. By doing so, we humanize our practice, share in the life of our patients and, in return, grow more deeply human.

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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 2013, to mark the 13th year of the Essay Contest students were given the pair of prompts that were used in the inaugural Essay Contest: “What do you think are the barriers to humanism in medicine today?” and “Who is the ‘good’ doctor?” More than 300 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 3 essays were selected along with 10 honorable mentions. Winning essays were published on the Arnold P. Gold Foundation Web site (www.humanism-in-medicine.org) and will be published in consecutive fall issues of Academic Medicine.

© 2013 by the Association of American Medical Colleges