A Medical Experience that Taught Me About Humanism in Medicine : Academic Medicine

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Gold Foundation Essay

A Medical Experience that Taught Me About Humanism in Medicine

Mendler, Jason MD, PhD

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We had just run across the hospital to the code. There lay a woman of 36 years, fighting her final battle with the breast cancer that had overtaken her body. The sun was shining through the room's window, illuminating the youth of her face, the other-worldliness of her eyes, the neat rows of braids in her hair, the large oxygen-carrying mask on her face. She was crying out, in high-pitched moans as if she knew that this would be her last chance to communicate with this world. What was she trying to tell us?

What had her life been like before she became ill? Where was she born and where did she grow up? What kind of things did she like to do? Who was this person that we had the privilege of meeting only in the closing act of her life?

The monitor to which she was hooked produced startling beeps as her oxygen saturation steadily dipped from the low 90s into the 80s and then into the 70s. Her heavy gasps were evidence of her lungs' desperate search for air. There was confusion about what her code status was. The resident, who had not known the patient until now, was called upon to conduct an impromptu family meeting. I watched from afar as he sat in the middle of the patient's father, mother, and two sisters, trying to calmly gather what the patient and family's end-of-life wishes were. Should we begin CPR? Would we intubate if her breathing became worse? There were tears streaming down her mother's face as she realized that this would be the day that her young daughter would die. Word quickly came from the resident to the nurses and other housestaff in the patient's room.

We would not be starting CPR. We would not be intubating her. Our goal was to make her as comfortable as possible in the last moments of her life. Many of the housestaff filed out at that point. Left in the room was one of the patient's sisters, who held her right hand, and one of the nurses who held her left hand. The nurse began injecting morphine into her IV line. Her sister began talking to her about the movies they were going to watch that evening back at home since she was supposed to be discharged later that day. All of a sudden, the monitor alarm again beeped, as if a final reminder of our futility in curing this woman of her cancer. The nurse turned to me and said something that I will never forget. “Please turn off that monitor. All we need now are our eyes and our hearts.” Using her eyes and her heart, the nurse responded to her patient's needs.

When her patient struggled to breathe, the nurse increased the oxygen. When her patient cried out, the nurse increased the morphine drip. When the patient appeared to need a friend, the nurse held her hand tightly and caressed her forehead. The patient died a few hours later. Watching this nurse care for her dying patient was as powerful a display of one human being caring for another as I have ever seen.

At its essence, the practice of medicine really is as simple as one human being caring for another. Sometimes it seems that in our rush to gather the hard data, order the next laboratory study, or research the literature, we forget to use our God-given senses to explore who our patients are and what they need from us. For instance, is it not uncommon for us as medical students or interns to preround by frantically gathering the vital signs, the medications, the laboratory data, and the radiographic reports only to find that we have run out of time to actually see the patient? Can we not become better at engaging our patients with questions such as “what is your favorite book” or “what is your favorite baseball team” so that we learn about their souls and not just their physical ailments? In our quest for efficiency, are we spending enough time studying the subtle expressions in our patients' faces that reveal their true experience of disease?

The high-tech, fast-paced world of modem medicine often feels like a chilly place. Medical professionals frequently worry about increasing debts and decreasing reimbursements. There is pressure to be better than our peers—so that we can get the more prestigious residency, so that we can publish first, so that we can get the next promotion. There is a feeling that other medical services are “dumping their work on us.” There are more patients to see and less time to see them. We feel tired and overworked. Although these are arguably harsh realities of modern medical practice, there is a danger that they will distract us from fully connecting with each of our patients.

We must strongly guard against this happening.

What made this nurse's actions so special was her full engagement in the management of her patient's death. She had a vision of how to make her patient comfortable and carried it out with great courage and compassion. She wore her heart on her sleeve and used it to guide her interventions. There were no treatment algorithms to follow nor laboratory tests to order. Her actions were visceral, instinctive, and heroic.

She would never receive any thanks from her patient, yet she would have something far more lasting—the inner satisfaction at having healed a soul. My mind filled with wonder as I contemplated the magnitude of this whole experience. Despite the immensely sad death of a young woman, I felt that everything was OK in the world. I was reawakened to the beauty in medicine. The hospital felt like a warmer place.

© 2005 Association of American Medical Colleges