“My doctor’s love is as important to me as his chemotherapy, but he does not know.”
I read this sentence and tears roll down my cheeks.
I am alone on a hilltop somewhere without a name in New Zealand and the sun is out and everything is idyllic but I am weeping.
This sentence hits me somewhere I am unable to access by will, somewhere that is beyond rational thought, at the substance of who I am at my core.
I’m reading Dr. Rachel Naomi Remen’s Kitchen Table Wisdom and in it she tells the story of a cancer patient who felt his chemotherapy was no longer helping him, but who continued to receive the weekly treatments because it was the only way for him to spend time with his oncologist. He shared with her that the meaning of just fifteen minutes with someone who was able to listen without fear and understand without distress was so profound, he was willing to do whatever it took. Ironically, she also happened to have a therapeutic relationship with that very oncologist through which they discussed his feelings of depression and worthlessness, but of course neither of them knew of her connection to the other.
She was affected deeply by this experience and says, “for a long time, I had also carried the belief that as a physician my love didn’t matter and the only thing of value I had to offer was my knowledge and skill. My training had argued me out of my truth: medicine is as close to love as it is to science.”
I sit for a while and process what I’ve just read, pondering why this is and how it happens. Eventually what comes up for me is a single word:
Throughout my own training, it’s been this word that’s tried to argue me out of my own truth.
It’s been my experience that the threat of being labeled “unprofessional” is used quite often to discourage my peers and I from embracing our humanity.
Showing emotion? Unprofessional.
Being open to the idea that healing is a two way street and that we too can receive something from the patient-doctor relationship? Unprofessional.
You get the point.
I was always so frustrated by this that I’ve come to dislike the word “professionalism” immensely. I tense up when I hear it used, regardless of the context. And it’s always made me wonder, “Are we cutting ourselves off from the profound healing power of authentic human connection in an effort to hold onto the false security provided by what we deem professional? By what we deem objective? By what we deem appropriate?
I’ve felt alone in this feeling for much of my professional (ha!) life. My peers never seem as bothered by it or maybe they just drink the institutional Kool-Aid more willingly than I.
And then I came across a quote from Rachel where she speaks the words in my heart I’d been afraid to say aloud, “Physicians have been trained to deny their wholeness in the mistaken belief that this would enable them to be of greatest service to others.”
I think back to a time when I threw professional distance to the wind as a senior medical student. On one of my rotations I met a woman with Spinal Muscular Atrophy (SMA) and I was instructed to go into the room to perform a physical exam–to see how disease had manifested in her body. When she broke down crying in the middle of our exam, I stopped and I listened. I didn’t complete my exam, I didn’t ask the questions, I didn’t try to fit her into the box of medical decision making, I didn’t hide behind my wall of professionalism.
I just listened. I tried to understand and I chose to be present in her suffering.
We cried and we smiled and we hugged. And what the experience taught me was the value of genuine human connection and the potential for our shared suffering to unite humanity as one.
I’m incredibly lucky to have had this experience, I know. And in a setting where I was encouraged and supported and appreciated. In this most formative of times in my medical career, I took the risk of baring not only my stethoscope but also my heart on my white coat sleeve and was met with positive reinforcement by my superiors, with gratitude and with love.
A year ago I met a woman while taking the practical portion of one of our medical board exams and she shared with me a similar experience that could not have gone more differently. As a native Spanish speaker, she explained that she was often asked to translate for the attending physicians and that there was one particularly difficult experience in which she was asked to tell a family that their child had Cerebral Palsy–an irreversible neurological condition that in this child’s case was so severe he would never be able to take care of himself. He wouldn’t walk, he wouldn’t talk, he wouldn’t be able to have relationships, he wouldn’t go to school, he wouldn’t do any of the things that we expect to add up to a life. The weight of this news hit the family hard. They weren’t prepared. They thought their child’s feeding difficulties were related to reflux, something he’d outgrow, something that would have no bearing on his future development. Now that this was being conveyed by someone who spoke their language fluently, they understood and it was hard. Really, really hard. So as the family cried, the medical student, who by the way shouldn’t have been put in this situation as a medical student (that’s why there are trained professionals who’s job it is to translate), began to cry quietly along with them. The doctor she was helping turned to her and said sternly, “Pull yourself together.” She was then reprimanded privately and told to apologize to the family.
APOLOGIZE? FOR BEING A HUMAN? FOR HAVING EMOTIONS? FOR GIVING A DAMN ABOUT THE PEOPLE IN FRONT OF YOU? I was floored. I’m lucky enough to be surrounded by a medical community of many like-minded individuals who share similar viewpoints on what it means to be a competent, caring physician who haven’t forgotten that we’re all human beings first and doctors second. I’ve actively worked to find this group of individuals who I resonate with and who lift me higher, so when she says this I am shocked. And appalled. Is this still happening? It’s 2017 and we’re still shaming our healthcare professionals for CARING about the people they take care of? And for showing it? For being human? This is a group of people that are categorically perfectionistic and uncompromisingly hard on themselves that we’re talking about here. Call me crazy but I think we should be praising our doctors for being authentic, not shaming them for doing the work it takes to get there.
What is most professional is not always most healing and, to me, that oath is greater.