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Teaching and Learning Moments

Heavy Moments

Lenze, Nicholas R.

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doi: 10.1097/ACM.0000000000002808
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First year of medical school.

On the wards for the first time, awkward.

Not long ago, I was beaming with pride in my new white coat.

Now, scared and humbled by the reality of my ineptitude.

Equipped with a recent lesson on how to take a social history.

Physical exam? Still a mystery, an awe-inspiring skill, something reserved for the medical gods.

I focus then on the social history.

Recently divorced, living in a homeless shelter. Used to drive buses for a living.

Alcohol? 6-7 drinks/day.

CC: suicidal thoughts with a plan.

What was the plan? I nervously ask, fully conscious that I am undeserving of this intimacy.

I had a gun and was ready to shoot, but I panicked and called my friend.

Thank God for her. She offered me a couch to sleep on when I leave the hospital.

Out in the hall, my preceptor declares she is ready for discharge.

Seemingly unfazed by the recent events.

I am shocked. And for weeks, I wonder if she is still alive.

Third year of medical school.

Outpatient psychiatry clinic, same old routine.

Confident, I begin a new patient evaluation as my resident evaluates me.

CC: f/u from recent psychiatric hospitalization.

Can you tell me about what happened leading up to the hospitalization?

Depression since high school, high expectations from parents.

Escalating tensions with girlfriend. Some alcohol involved.

I drove up a remote mountain and swerved off the road, over a cliff.

Still alive, I threw myself into the rocks down the embankment, desperate.

Still alive, I started slitting my wrists with smaller, more jagged rocks.

But I couldn’t remember the right way to do it, horizontal or vertical.

I listen and attempt to show compassion with my eyes.

Still fully conscious that I am undeserving of this intimacy.

Now, I know that nobody is. The long-coated medical gods, even they are human.

But the visceral discomfort that once kept me up at night is gone.

Its absence bothers me.

Still, I sleep soundly at night.

Seemingly unfazed by the recent events.

As part of an Ethics & Humanism course built into my third-year curriculum, I was challenged with the task to intentionally pay attention to my new surroundings and my gut response to them as I progressed through the wards. As the year evolved, I noticed a trend toward a normalization of the extraordinary—fragile moments where every word and every touch have the power to alter the course of a human story. Moments like these, I’ve learned, are abundant in the field of medicine. They remind me of the great privilege and responsibility we have when patients invite us into their lives. It was a little unsettling, then, when I realized these moments no longer affected me the same way as before. I worried that one day I might become numb to these experiences altogether.

After much discussion with peers, I’ve come to believe that this normalization is a common experience in the journey to doctorhood. Just like any experience, the initial shock of seeing a suicidal patient begins to fade as it happens over and over again. Bearing witness to suffering is a daily occurrence in the field of medicine, and fragile moments can lose their novelty. Without pausing to reflect on them, I think it would be easy to continue on a path to insensitivity and burnout. Attendings have always warned me that the third year of medical school is notorious for a decline in empathy, and I can imagine why. Normalization can be harmful, but if it is recognized, it doesn’t have to be.

The lesson, which I owe to my Ethics & Humanism professors, is simply to notice—to remain aware of the happenings around us, in the hospital or the clinic, and to occasionally ask ourselves, “What makes this moment significant?” When I did this, I was able to feel the weight of the circumstance with my suicidal patient, as well as the sorrow and fear that came with it. Importantly, I was still able to continue seeing challenging patients for days, weeks, and months to come; that’s what we are trained to do. The nature of clinical medicine teaches us to hear difficult stories from patients without being knocked over by them. But I think it will require intentional awareness and self-reflection throughout my career as a physician to respect every heavy moment for its immense worth.


The author wishes to thank Katharine Meacham, PhD, and Ira Sloan, MD, for their wisdom and guidance in Ethics & Humanism.

Copyright © 2019 by the Association of American Medical Colleges