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Special Theme: Complementary, Alternative, and Integrative Medicine: GOLD FOUNDATION ESSAY

The Clinical Experience That Taught Me the Most

Bewtra, Meenakshi

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The clinical experience that has taught me the most began before I ever entered medical school and will continue every day for the rest of my life.

At the beginning of medical school, I became ill and was diagnosed with Inflammatory Bowel Disease. Overnight my life changed. Before, I had been a full-time student. Suddenly I also became a full-time patient learning first hand the difficult lessons of living with a chronic disease. No textbook can teach someone what living a life with a chronic illness means. I quickly learned that many physicians don't fully understand the ramifications of the diseases they diagnose or the medications they prescribe. Instead of being able to go out to dinner with friends, I was forced to cook all my meals because of the severe dietary restrictions my condition required. Instead of sleeping in or staying out late, I had over 30 pills to take at set times throughout the day. And I became so embarrassed about my condition, and afraid of my frequent bowel movements, that I stopped socializing with my friends. Whereas I had always been energetic and enthusiastic, I now found myself constantly fatigued. The host of side effects from my medications left me feeling like I had not one but two or three diseases. Many times I became so upset and frustrated I could do nothing but cry.

The day before the second semester began, I woke up blind. That episode began the hardest six months of my life: I had thrown a blood clot to my retinal artery. I was admitted to the hospital and found to have extensive refractory disease, a hemoglobin of 6.2, and ischemia of part of my small bowel. I spent two months in the hospital. In all, I had over thirty colonoscopies, endoscopies, scans and other imaging studies done, six blood transfusions, and a Groshong line. A three immunosuppressive drug regimen finally controlled the illness, but by that time I was losing my hair, unable to walk, not allowed to eat, receiving TPN, Cushingoid, and suffering multiple other side effects of various medications. I watched my physician parents age with worry and I myself became severely depressed. My life turned upside down, I had little hope that I would ever recover, and I could tell that my physicians were pessimistic as well.

Throughout this time, the most popular phrase recited to me by physicians, nurses and visitors alike was, “You will be such a better doctor because you've gone through all of this.” I began to hate hearing those words. There is a humiliation that occurs when you become a patient, a humiliation that is beyond the scope of any essay to describe. I had been a healthy 23-year-old medical student, but now was trapped in bed wearing a diaper, unable even to go to the bathroom by myself. Doctors came in and out but never explained my condition or prognosis. I began to resent those who could simply leave the hospital at the end of the day and go on living their lives.

Eventually, I did leave the hospital, and I began learning to live again. However, it took a longer time for me to recognize the value of my experience. This realization didn't come in one brilliant flash of insight, but rather in the accumulation of numerous smaller ones: seeing a blind man on a bus, or a young woman in a wheel chair, enabled me to empathize with these people in a way I could not prior to my illness.

When I began working in the hospital, I took care of a 37-year-old man who was diagnosed with AML. He was a professional cyclist, who was married with two children, and had been completely healthy prior to his diagnosis. As the disease progressed and he became weaker and sicker, I saw the same depression and resentment in his eyes that I had felt.

One afternoon I went to his room, sat down and before I knew what I was doing, I found myself telling him about my experiences with illness: how I had refused to talk to anyone for days because I had become so depressed; how embarrassed I had felt when I couldn't get to a bathroom fast enough and had an accident in bed; and how even now I sometimes think about myself prior to my illness and become saddened because I feel like I'll never be a “normal” person again.

Then I told him something that, until then, hadn't really sunk in for me: I told him that the most important thing for him to always remember was that this disease did not define him. He was not a lab count, or a disease name, or a test result. He was a person. And this disease was only a part of him. Yes, it would change his life—and yes, it would change who he is. But he was far more than this illness; and the sooner he reminded himself of this, the sooner he could gain control over his life again.

That was the moment when I myself realized how much I had learned; how, in a strange, twisted way, I had been blessed when I had become ill. Until that time, I had never truly known how strong I was or how lucky I was. And with that insight, I was given the ability to show others in similar situations the same thing about themselves. While not being a “clinical experience” in the traditional medical school sense, my experience as a patient—and as a person with a chronic illness—has taught me that every disease, every lab result, every imaging study is actually a real person with a real life. What we do as physicians is more than just making diagnoses or performing procedures. We change people's lives. That is why humanism and medicine must go hand in hand. My experiences may make me a better physician; they have certainly made me a better person.

The Arnold P. Gold Foundation, Inc., is a public, not-for-profit organization founded in 1988 to nurture and emphasize in medical school and teaching hospital programs the medical profession's time-honored tradition of caring. The Foundation believes that compassion and respect are essential in the practice of medicine; that cooperative relationships between and among caregivers and patients increase trust and enhance the healing process; and that medical role-model practitioners who embody these values deserve support, encouragement, and recognition.

The Foundation supports 26 diverse and innovative programs throughout the United States and in other countries that are designed to foster humanism in medicine. In 1999, the Foundation instituted the annual Humanism in Medicine Essay Contest as a way to encourage medical students to express themselves through reflection about their experiences.

The theme for the 2001 Humanism in Medicine Essay Contest was “The Clinical Experience That Taught You the Most.” The Gold Foundation received 358 submissions from more than 110 allopathic and osteopathic medical schools. Winning essays and honorable mentions were selected by a distinguished panel of judges. Academic Medicine is pleased to publish the top three winning essays from the 2001 contest; the essay by the first-prize winner, Meenakshi Bewtra, appears below. The second- and third-place essays will appear in the October and November issues, respectively.

The theme for the 2002 contest is “A Humanistic Role-model in My Medical Career.” Any student from an accredited medical school may enter. Cash prizes are awarded for winners of first ($1,000), second ($500), and third ($250) place and up to ten honorable mentions. The deadline for entries in 2002 is September 30. Winning essays will also be published on the Foundation's Web site: 〈www.humanism-in-medicine.org〉 and in the Foundation's DOC newsletter. Individual judges' names may also be found on the Foundation's Web site. For further information, please call The Arnold P. Gold Foundation at (201) 567-7999 or e-mail: 〈goldfdtn@gold-foundation.org〉.

© 2002 Association of American Medical Colleges