I’m sitting in a coffeeshop sipping on what I have grown accustomed to calling a cup of courage, staring at a blank word document scouring my mind for words to describe my heart. Perhaps I should start by inviting you to sit down with me as well, with your own cup of courage, to calm my nerves, to create the atmosphere in which I can be open to answer such a perplexing question as how do I represent humanistic medicine. In this quiet nook we’ll sit, against floor-to-ceiling windows, with the soft light of early morning filtering in, and I’ll try to slowly dissect the chambers of my humanism. In the background will be the sound of machines grinding coffee beans, a pleasant static background noise, an entirely different world from the beeping of telemetry monitors, mechanical ventilators, and pagers. I’ve chosen to be here for this reason, to remind myself that I study what I study so people connected to machines in hospital beds facing the worst day of their lives will one day be sitting in coffee shops sipping on their own cups of courage, looking ahead to best days to come. It is in these small nooks, observing a drastically different world than the one I navigate, that I am reminded of humanism.
Deep breath. My chambers are filling.
If I’m being honest, I’m not sure how to define humanism. Would it be cliche for me, here, to quote the dictionary? Many system or mode of thought or action in which human interests, values, and dignity predominate. So how can I do what you’re asking me — how do I explain how I take into consideration other human interests, their values, and uphold their dignity in a field in which this must be the fundamental basis of our actions? How is this different from the Hippocratic oath I took at the beginning of my medical school education, where I promised my hands shall never do harm to a human being, and sealed that oath with a crisp, white coat that shined brilliantly against my desert skin and reflected the proud smiles of an ancestry that never held a medical degree to its name? I could do it, if you truly wanted me to, share stories that highlight my commitment to humanism. But I do not find these to be special and I fear by speaking them I’m reducing them to performative acts. These stories are not the definition of humanism. There are no steps, no evidence to provide to prove compassion, no way to scientifically quantify the desire I have to connect to others at a visceral level. I think this is what I’m struggling with — how do I explicate what is so engrained in every cell of my being? Does the heart not pump because of the pressure exerted on it? Does it not pump simply because it must?
Lub.
The biggest lesson I’ve learned in humanism doesn’t come from my actions towards my patients, but rather from moments in which I utterly failed. In many ways “humanistic medicine” taught me to reflect inwards and learn what should have been the most obvious lesson of all: I am human too, and I must learn what it means to be kind to myself.
I once sat and choo-choo trained milk of magnesium to a woman with hepatic encephalopathy refusing lactulose. It was early in the morning, before rounds. The nurse called our team room with yet another vital medication refusal, and the sleepy-eyed resident and I climbed down the stairs and badged into her ward, and pulled the curtains back to a woman so jaundiced it was as if she lay there in banana skin. We were in the gray zone medicine often finds itself: here was a woman, confused by increasing toxins in her blood affecting her brain, but not confused enough to the point where we could call her incapable of making her own decisions and thus force adherence to life-saving medications. Instead we pleaded, urged, begged her to take medications that would clean her blood of the toxins destroying her brain. I sat at her bedside, with milk of magnesium on a tray, and a plastic spoon, and used all the tricks I used with young children to get her to open her pursed lips so I could give her some medications that would relieve her digestive tract of the bilirubin that deposited on her skin. I only got a couple of spoonfuls in her mouth, and lost most of it to the towel beneath her chin. In that moment I recognized that in all of my desire to help and heal, somedays I’ll fall short. That has nothing to do with my capabilities as a future physician, nor does it reflect as a failure within myself. I had to learn that I could not help a person who was not determined to help themselves first, and I could not let that burden sink in my soul. Despite that, I must keep trying.
I sat with a naive mother with an active CPS case against her globally delayed child. Her child was brought in after a fall that fractured a bone. As is customary in medicine, when the history of mechanism of fall doesn’t match with the fracture that glows on X-Ray, we suspect abuse and an investigation ensues. The mother was furious, and as evidence started to pile against her, the case became more and more devastating. I sat with her for hours, listening to her side, explaining to her what the doctors saw, trying to build trust in a woman who was losing it by the second. By the end of it, she refused to talk to me. Some visits I would walk into the room and she refused to say a word, other times she yelled and I stood patiently, somehow feeling guilty and thus deserving of her wrath, other times she didn’t even let me enter the room, and I left dejected back to my team. She wasn’t a horrible mother, she was simply naive in mothering and misguided. What medicine said was developmental delay, she called late blooming. She didn’t understand why we were concerned about the matted hair, the skull bossing, the lack of communication of a one year-old, all the signs we look for when we consider intervention. She didn’t believe the institution of medicine understood her child. I remember patiently explaining to her for hours, in the morning, in the afternoon, calling up previous doctors, and creating follow-up appointments, and writing novels for notes in which I had to think of both mother and child, and it was the most difficult two weeks I have ever had to handle. At the end, no one was satisfied with the decision. I was forced to learn that there are struggles never meant for me to carry, no matter how I wished to bear their weight, that healing within itself does not entail bearing the weight of another person’s struggle. Healing also does not stop with white, sterile walls. I simply had to do my job.
When a patient, waiting on his third heart transplant, asked his wife if I was a terrorist, I caught not his fear in me, but the recognition of his own mortality in his eyes. Though taken aback, I did not blink. I did not let it tear down my confidence, or even harbored anger against him. I continuously reminded myself of my privilege. At the end of the day, I was able to hang my white coat and stethoscope in team rooms and take off my student doctor hat, and enjoy the rare breeze of a hot, Houston afternoon. I wasn’t in a hospital bed, hooked to machines, terrified of an uncertain future. I didn’t spend my nights staring at mortality at the corner of a hospital bed. How could I be furious at him? What right did I have to determine how a person reacts to the idea that they may no longer be? This was far larger than myself, and in hospital halls I am merely the guide.
Then there was the time I sat talking to a veteran and his wife. Our team was doing a cancer work-up. He wasn’t diagnosed with cancer yet, but his mind was preparing him for the worst. I listened, as I do, when simply being present is the best healing I can provide. He shared his dreams, his wife laughed at memories, and I told them we can’t make assumptions, maybe it’s time to make those dreams reality, and he cried, and then he apologized because military men do not cry in front of young women. I told him that he did not need to apologize for being human, for being scared. It was my attempt to comfort, to let him know courage is not the absence of fear. I wonder now, if perhaps, in comforting him, I was also trying to comfort myself. I walk into rooms with a white coat that my patients believe are filled with knick knacks in my pocket that will solve their problems or save their life. They do not know my mind is overflowing with facts I am struggling to keep in it, that sometimes I walk into their room leaving a heart shattered by my previous patient at the door, that the stethoscope around my neck has listened to pathologies my tongue dreads speaking. They do not know how I must give my being in every room I walk into. That when I walk out, I must shake the weight off my shoulder. That I must then reset — my mind, my heart — knock on a new door, and enter with my being as if it wasn’t shattered to pieces a moment before.
A resident once told me that if I wanted people to thank me, I’m in the wrong profession. I don’t think I’m waiting for people to thank me. I think maybe, I’m just waiting for them to see how equally human I am.
My chambers are emptying.
Empathy comes in many forms. It can be clear and concise. We learn statements throughout medical training known to provide comfort, and no matter how robotic they may feel on our tongues, they are a melody of validation to ears craving their sound. Empathy can be calm and gentle; a soft touch on the shoulder that says yes I am here, a box full of tissues waiting, encouraging to please, continue on. It can be silently powerful — let words, fears, fill up a space they were never granted permission to occupy. At its purest, empathy is simply asking questions for answers that need to be listened to. No matter what form it presents itself, it has the unparalleled capacity to nourish and heal.
Staring at this document on my computer screen, I think of what it means to be a member of the Gold Humanism Honor Society. I am reminded of the time I witnessed an organ donor being wheeled into the operating room, the collective moment of silence as we held our breath for one final act of compassion. Of the hours I’ve spent after rounds sitting with patients and giving them company, from COPD exacerbations to malaria to metastatic brain cancer. I’ve witnessed the ways this experience has transformed me from a naïve pre-medical student to a person who is a year away from having the responsibility to heal. I’ve witnessed how medical training has a way of wrestling with your humanity, makes you feel you are never enough, delivers news of terminal illnesses in a row and refuses to shed a tear, pushes you to prove worth with every move made, and forgets that we are oftentimes kinder to everyone but ourselves. I’ve tried to embody what it means to be caring, kind, empathetic, compassionate, and to do so while carrying burdens on my shoulder only few in this world are permitted — privileged — to carry. I strive to continue carrying them with knowledge, with grace, with humility.
I’ll be spending a lifetime learning — about myself, my patients, what it means to be human, to enjoy a life filled with love, grief, pain, triumph, resilience — and I think of how I’m finally starting to see the foundation I’ve built. How I’m finally, maybe, starting to build upwards.
Dub.
This heart of mine has lead me on a journey to uncover the silent, untouched, corners of this earth at the end of my stethoscope. I carry the discoveries with me in the pockets of my white coat. In many ways I came to medical school hoping to change the world, naive in the capacity in which I could. Changing the world isn’t what I thought it would be, and this journey I’ve embarked on is nothing of what I imagined it to be. It has become more than I ever thought it could become. Changing the world now, and the idea of humanism, to me, means something quite different: kindness, to myself, humility, and light. Being kind to myself, embracing humility, and exuding compassionate light.