I’m a resident doctor, a brand new doctor. I just started my residency training. The process of becoming a doctor is long and tedious and involves an enormous amount of hard work and commitment. We complete undergraduate studies, four years of medical school and three to five years of residency. The hardest part, however, is not the studies or the professional endurance – but rather the development of a personal and professional identity by bearing witness to the suffering of your fellow man.
As people, we collect experiences through our lives that shape us and shape our narrative. A number of these stories are joyous. Some are mundane and only matter to the individual. And unfortunately, many are sad, even tragic. By the time people are in their sixth, seventh or eighth decade on this earth, they have accumulated so much experience. These experiences offer them a certain perspective – call it wisdom or maturity – that allows them to contextualize new and stressful events in ways that young people simply cannot. They say things like, “After all my years, nothing surprises me,” or “I guess that’s the way life is,” or “Time is fleeting; you have to make the most of it. These statements reflect an advanced worldview, one that young adults cannot fully comprehend.
As a medical trainee, you are suddenly exposed to enormous amounts of human suffering as a fairly young adult. I started medical school when I was 23. I am now 27. Our systems are flooded with so many human stories, and we are collecting “experiences” at a much faster rate than the average person. While some of these stories are hopeful, most are underlined by sadness and loss. And yet, I don’t have the benefit of sixty years of character formation. I was not able to do a great retrospective of the experiences I have accumulated to better understand the existential arc of my life, as a septuagenarian can do. I see adversity here, now. I see sickness and the end of long lives, as someone in my twenties, and I just don’t know what to do with it.
Immediately, I ask: Should I mourn with my patient and his family? Should I go back to work right away? Don’t cry, or maybe just a little? Why am I thinking so much of myself when the people before me are grieving? Longitudinally, I ask: Where in my personal narrative do I place the great amount of suffering I am exposed to? Does it become an indelible part of who I am? Do these stories become anecdotes about anonymous people that I share when I meet people, the way lawyers talk about their clients or professors talk about their students? Or do I store these experiences in a less accessible part of myself, far from conscious reach? This is the difficult process of identity formation that we have to go through as young doctors.
We are taught to establish empathetic relationships with our patients but also to create professional boundaries to get us out of the maze that is human grief. There are no specific rules on how to address patient tragedies. Each doctor does it differently. I have seen some doctors cry when discussing poor prognoses with their patients. I see some maintaining a chilly detachment. Many straddle the line well between compassion and emotional distance.
Physicians must devote a large part of their personal and psychological work to their relationship to human suffering. This relationship does not happen overnight; it is constantly changing, and it is never perfected.
So here I am, as a doctor in my twenties. I have my credentials. I submit my intellect and knowledge of human pathophysiology. I am armed with the fragile skills of empathy and compassion. But I have little to offer, in terms of basic wisdom or maturity, to suffering patients who are 40 years older than me.
And yet, patients grant me their deepest certainty. They trust me to heal them, to heal their wounded bodies. Their legendary bodies. Bodies holding decades of experience, who have spent the better part of a century as inhabitants of this physical world. Bodies that have served them well for many years, now before me – someone who knows so little about the scope of his own life. These patients, these people, they allow me to treat them and, in doing so, to integrate their stories into my personality. And when I speak, they listen and they call me “Doctor”.
Kathryn Tabor is completing her medical residency in Michigan.
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