Friday, December 24, 2010

A Medical Intern's Christmas

As we close this week on Work & Life Balance here at Scrub Notes, we are thankful for our guest authors who shed light on some of the issues affecting doctors and patients today that are not "pathophysiologic" in origin. We have heard about how to maintain balance as a medical student, for as any provider can tell you, if you are not in balance, how can you help restore order to your patient's life, especially one that has just been thrown a curveball with a new diagnosis? At times, we fail to maintain that balance, either because we are unable to manage the stress of our profession, or we fail to live up to the high academic standards we have set for ourselves. How medical students manage stress is a key skill that is not often directly addressed within medical schools. These skills often end up being more important to a successful patient interaction than all the pathology and physiology trivia one learns, whether dealing with patients with alternative backgrounds, or just learning how to handle the stress of the first night on-call.

As we end the week, many medical students, interns, and residents will not be celebrating the holidays with their families. Instead, they will be on call, or night shifts, or just long schedules, taking care of patients. For life and death, sickness and health, do not take holidays, and nor should our compassion for taking care of those who are in trying times. I recall working last year on Christmas Eve at the VA on an inpatient medicine rotation. Trust me, the VA hospital is probably close to the last place you want to be almost any time of the year, let alone Christmas. It is strange to say that in some ways. For the most part, the patients, staff, and doctors are all nice and well-intentioned. However, the VA simply is not home, and everyone should be home for the holidays, patients and providers alike.

But, as said above, illness does not care for such sentimental notions, so we must make do. The staff had put up a Christmas tree, and many patients' families came by with gifts or just to spend time with their loved ones. For that's what we as human beings do: we adapt. We make the best of what we have. We pull together and create a sense of family and home in even the most trying of situations. A diagnosis of cancer or heart failure or AIDS is not tantamount to a diagnosis of ill spirit. Although the patient may not see the promise that their life still holds, it is up to the caregiver to gently nudge them towards making the most of their time, whether they have days, months, or decades left. To do so, we must put aside our selves and our desires and truly empathize with the patient.

To be honest, going into the hospital that day, I had no intention of empathizing with anyone. It was a pity party: who was empathizing with me, the woeful intern stuck in the hospital when everyone else was at home relaxing or making merry? Yes, the cynicism of intern year had set in. But as the day progressed, I realized some of the ideas described above. If anything, it was one of the better days of the month - there truly was a festive spirit in the air. Like Scrooge, my cold heart mellowed. What would I really have done with the day off? Likely not much, nor did I have any grand plans. Instead, I ended up spending the day casually rounding (no conferences or discharges to worry / stress me), meeting the often-mentioned-but-never-seen almost mythical family members. The patients were happier around loved ones, sharing stories and laughs, letting me peak into their actual lives. We could all put aside worrying about lab results and planned procedures, and simply enjoy the presence of being together.

And ultimately, that is what medicine should be about. It should be about providing a sense of support for those in a time of weakness, whether that be mental or physical. Being the surrogate family when one's own family is not around. Throughout that day, as the clock slowly moved forward to my own departure from the hospital, I was reminded of the transient nature of my presence there. Sure, I could bemoan my lot, stuck there, but hey, at least I got to go home at some point. None of the patients were leaving that day, and many would not leave for many more days. Whether Christmas Eve or any other day, our role should be the same: providing a supportive environment to help the patient heal themselves,  both physically and mentally/spiritually, for a true physician should care for the totality of the patient, not merely their lab values or functional status. During the holidays, our goal as providers should be to provide a holiday worth remembering for our patients, which coincidentally should become a holiday we cherish ourselves.

Happy Holidays from Scrub Notes! See you next year!

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