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A Show of Emotion

Lenze, Nicholas R.

doi: 10.1097/ACM.0000000000002664
Teaching and Learning Moments
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N.R. Lenze is a fourth-year MD and MPH student, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina; e-mail: nicholas_lenze@med.unc.edu; ORCID: https://orcid.org/0000-0002-2126-6663.

An Academic Medicine Podcast episode featuring this article is available wherever you get your podcasts.

On the first night of my labor and delivery rotation, I watched a story unfold that reminded me of medicine’s potential to arouse our innermost humanity. The emotional response these events elicited from my preceptor affected me as deeply as the experience itself.

My patient Zoey was a 20-year-old Spanish-speaking woman from rural North Carolina. She was 21 weeks pregnant and presented with vaginal bleeding and contractions. Further workup revealed an intraamniotic infection, which had caused her fetal membranes to rupture prematurely. I discussed the case briefly with my preceptor, and she confirmed my fears. If we used medications to delay labor until the age of fetal viability, the fetus would surely die from the infection. At this point, our primary goal was to save Zoey’s life.

I entered Zoey’s room to find a young girl lying uncomfortably in bed. “Como se siente?” I asked her. How do you feel?

She described a dull pain in her lower abdomen and asked when I thought the baby would come. I glanced at the bags of fluid dripping into her IV. Oxytocin should quicken the process, I explained. In all honesty, though, I had no idea whether it would be minutes, hours, or days.

Before long, her contractions began to accelerate. Only five minutes passed between each cringe of intense pressure. Through heavy breaths, Zoey requested that a neonatologist be there when the baby was born. I soon realized that she had hope, even the expectation, that the fetus would be viable.

Unsure of how to navigate this delicate situation and handicapped by my broken Spanish, I withdrew to the hall and alerted the team. Moments later we were back in Zoey’s room with a brigade of health care professionals—my OB/GYN preceptor, two residents, a neonatologist, a nurse, a chaplain, and an interpreter. In a flurry of activity, the semisterile drapes were placed, and the stage was set for the delivery. Amidst the chaos, my preceptor tried to explain to Zoey that any efforts to resuscitate the baby would be futile.

Shortly after midnight, Zoey delivered a baby girl she named Sophia. Pale with tiny fingers and toes, squinting eyes, and a faint heartbeat, Sophia was beautiful. But she was not breathing. “Latido del corazon pero no respira,” the interpreter said in a soft voice. Her hearts beats but she does not breathe.

We placed the baby on her mother’s breast and stood around her, somber. I gently touched Zoey’s arm and prayed in silence. When I opened my eyes, I glanced at my preceptor across the bed. There were tears dampening her face.

I was moved by the sight of my preceptor in that moment, for she was a veteran of the hospital and had seen her fair share of tragedy. To know that she was still touched by a moment such as this one was, in all sincerity, refreshing. When I witnessed suffering in the hospital, I instinctively wanted to open my heart to those patients, to meet them on common ground. But there exists a great tension in medicine between emotional vulnerability and your perceived role as a provider.

After six months of being on the wards for my third-year clerkships, I had begun to notice a blunting of my once-vivid emotions. It had become easier to brush aside the patient in the emergency department who was screaming out in pain, eyes frantically scanning the hall for a sympathetic face. Or the woman with pneumonia who felt depressed after a recent divorce and really just needed someone to talk to. It was so easy to get caught up in the next task—scanning UpToDate for answers, preparing an oral presentation for rounds, or charting progress notes. But my experience with Zoey was a wakeup call, and it reminded me of why I chose medicine in the first place—the extraordinary moments of humanity we experience when we are present with patients.

As a medical student, I look to my preceptors as role models for patient care. Their interactions with patients provide a framework for how I conceptualize my own future practice. My OB/GYN preceptor that day showed me that it is possible to express emotion and still be an excellent doctor. While important boundaries exist between patients and providers, they are more nuanced than I once imagined. For the sake of my future patients and my own humanity, I hope that I can find that sweet spot.

Less than an hour after Sophia passed away, we brought a new life into the world via cesarean section. As the baby wailed its first breath, I heard the mother gush out in joy from behind the blue curtain. I looked over at my preceptor and, between her surgical cap and mask, her eyes were beaming. This time, it was I who felt the surge of tears.

© 2019 by the Association of American Medical Colleges