Day 12

The capstone of my third year of medical school was the crucial clerkship in internal medicine. How well you did in that clerkship was reputed to determine your professional future. I was at a lecture when my supervising resident, a few years ahead of me in her training, came into the classroom, tears in her eyes, and whispered to me that Mr. Quinn, a patient I’d been caring for, had just died. I got up and went with her to his bedside. We stood there together for a long time. He had been a feisty merchant marine, his face roughened from years at sea. I used to sit with him after those long days at the hospital, soaking up his stories, listening to his feelings about his impending death. He knew that his seventy years on the planet were coming to an end, his adventures almost over. Now his life story was complete, and the resident and I shared our reflections as we stood by the body that had sailed his ship at sea.

That afternoon I met with the senior attending physician for my mid-rotation student progress review. He was quite an imposing figure, tall, black-bearded, and handsome, an oncologist, who told me that I was doing a “fine job” in my clerkship—except for one thing. He noticed that I had left the teaching rounds that morning. I told him about Mr. Quinn’s death and about how my resident and I had wanted to stay with him until the orderlies came to take his body away. Then the physician said something I will never forget: “Daniel, you have to realize that you are here to learn. Taking time away from a learning opportunity is a big problem. You have to get over these feelings—patients just die. There is no time for tears. Your job is to learn. To be an excellent doctor, you have to deal with just the facts.”

No time for tears. Was this the art of medicine I was supposed to be learning?
The next day I went to Mr. Quinn’s old room to admit a new patient. There I found one of my favorite science instructors sitting on the bed. He smiled at me and said, “Well, I guess these diseases can happen to any of us.” He had developed acute leukemia, and I was supposed to begin preparing him for a bone marrow transplant. My face filled with intensity—first tears, which I held back; then fear, which I could not bear to sense; and finally stern resolve, a steely-eyed feeling of focus. I committed my mind to “get over” my fear and sadness and just attend to the details of what needed to be done. I ordered the necessary lab work, carefully administered the chemotherapy, watched closely for side effects, and intensely monitored my teacher/patient’s progress. I went to the library and gathered all the research facts I could about his form of leukemia, the treatment, and the prognosis. I presented these papers and the “clinical case” to my team of fellow students, residents, and supervising physicians. On teaching rounds in the patient’s room and beside his door, I discussed the technical details of the case with my attending and residents: just the facts, no feelings. I was careful not to spend much time talking with my patient. He was the sick one, I was the doctor. What was there to talk about, anyway?
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Over the last quarter century, science has opened a new window into the nature of our lives. We can state definitively that the mind, though not visible to the eye, is unequivocally “real.” Medicine too has progressed since those days. Harvard Medical School has changed, and many programs today give at least some attention to notions such as empathy and stress reduction in student physicians and the importance of seeing the patient as a person. I would have had a much better experience becoming a physician with such an internally focused, well-rounded curriculum.

~~Mindsight -by- Daniel J. Siegel, M.D.