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Practicing Residency

Justine Parker, DO

(Fam Med 2016;48(5):389-90.)

Partway through my family medicine residency, it became clear that I didn’t like medicine. Or patients. Or humans, generally. I looked around and saw everyone—colleagues and patients alike—bearing their own suffering. As holding the weight of someone else’s suffering is exhausting, I stopped.

But I used to hold the weight of things. Things. The sensuous, textured, rich details of things, with “happy” stories and “sad” stories and stories too enigmatic to do anything but feel them, deeply. I used to be in love with things: a feather on the sidewalk, amniotic fluid on my pants, a toddler being pulled across the street with such thick legs so new at walking, a cyclist—hit by a cement truck—surrounded by trauma surgeons resuscitating her for hours, with chest tubes, ultrasounds, and all the things that demonstrate their care, her lung so pliant under her ribs and the air leaving the pneumothorax so effortlessly.

As the months passed, however, feathers on the sidewalk and even newborn babies became flat. And I realized that flatness was painful to me. Even more painful was the dull recollection of the person who would have glanced at the feather and felt mystified at its perfect placement and curious about the bird who left it, now flying up into the thinning, cooling air. I could recall that person who, with vision and enthusiasm, would have gone on about the dream catcher that the feather could become a part of, as well as about the history of dream catchers and storytelling. But the person I became in the early part of my medical training—outside my body, crows feet, flat-faced—could not feel into experiences any more or hold the weight of things. I could not even hold the light weight of a newborn coming into the world. Standing at the perineum after handing a newborn to her parents, I would wait for joy and a sense of connection, but they didn’t come.

The month I started to feel this way, three of my patients coded and two died. Monique, born a he and now a she (despite the physicians’ joking and bumbling pronouns around her body), was one of the patients I tried to help die gracefully: gracefully, like a lemon ripening slowly at the bottom of the bowl until it rots quietly beneath the rest of the fruit. I had wanted her passing to be gentle, easy—maybe even elegant.

Instead, I bothered her family with eight different phone calls throughout the day. “What would she want done? Everything? Rib-breaking compressions? Electricity? Meds she’s already maxed out on?” In the end I cracked five of her ribs and she died twice, the second time permanently.

It would be too simple to say that the coding or the dying caused me to not like medicine, or people. In actuality, it was a flawed sense that my responsibility as a physician was to hold the whole weight of a patient. But before I realized this, I stopped trying to hold anything at all: I would put my hand on my patients’ knees effortlessly, I would make my voice empathic and move the muscles in my face to look concerned and receptive. I had muscle memory for connection. But I couldn’t feel a thing.

I began to have recurrent dreams of drowning, the cool water in a shallow river softening my bones. Likewise, I dreamed of scratching the skin of my wrists until they bled. At the time, I saw the poetry in it. While my body was wrapped in sheets and skin, my unconscious mind crafted an accurate metaphor for my days in the hospital. Having stopped holding the weight of things, I had inadvertently lost the ability to feel anything at all, and now I dreamed of scratching and clawing for a pulse, for feeling, for something so alive it could not be mistaken. Instead, I saw the dreams begin to overtake my waking moments.

So, like some of my colleagues, I started therapy, and, like more of my colleagues, antidepressants. I came to realize that I had to change my relationship to medicine and, thus, I began the claustrophobic practice of noticing again: feathers, fingernails, a song, a human being, whatever. I had stopped holding the weight of things without realizing that I couldn’t selectively numb emotions. Shutting myself off to the emotions of suffering, shame, vulnerability, and fear also meant that I numbed joy, gratitude, connection, and a sense of purpose and meaning. This practice of noticing again, of dragging myself into the present moment to experience whatever things I found there, helped me to begin to feel their importance and sensuousness again.

I had to relearn how to be in the present moment as a physician but also remain calm and still. This had been easy for me before entering medicine. But with the deluge of patient contact, 50–70 hours weekly, it was not easy for me to step back, detach, and reexamine the heavy myth that as physicians we need to heal our patients—all of them (if not most of them), and all the time (if not most of the time).

We don’t need to heal our patients, we need to be present to them so we can collaborate in their healing.

Patients are handing us their stories over and over again. I think reflexively many of us reach out and hold the weight of these stories. Ultimately, many of us collapse under the weight, unable to reach out for anything at all, be it suffering or joy. Rather than hold too tightly or releasing altogether, I have found that those times when I practice noticing are the times when I am creatively and whole heartedly engaged with medicine—and, delightfully, with my patients. These are spacious, often effervescent moments, where I can be amidst the suffering of others without being harmed by it.

During this awkward re-learning of how to be present, I got the page about Dayla. In the ER. Rule out miscarriage.

Dayla had become one of those patients whose name I love seeing on my schedule. She’s young and full of self-loathing, with HATE carved into her thigh, but she’s also resilient and tenacious. She evokes in me a deep desire to nurture, and when I see this page, my first thought is to run to the hospital, despite not being on call. But I don’t. This reflexive tendency to equate good caregiving with holding the whole weight of a patient’s problem had, in fact, alienated me from medicine. So I pause to notice the thought, with its associated anxiety, fear, and neck tension, then I make the deliberate decision to put the weight of it down.

I can’t change Dayla’s life or the society within which she is embedded. But at her next appointment, when she arrives still pregnant, I enfold this beautiful young woman in my arms, I rub her stone-colored carved up skin, and praise her power and capacity for connection— despite all the feedback she’s gotten that connection causes chlamydia, imprisonment, addiction. I validate her experience: the fear, fatigue, swirls of movement in her belly. I measure her fundus and fetal heart tones and ask about contractions and fetal movement. And—though I don’t hold the weight of it—I am present to the suffering, and ultimately the beautiful curly haired baby, she brings to clinic.

Acknowledgments: I thank Kate Rowland for her example of engaging the mystery of medicine through writing and my wife, Lia, for being present to me throughout this process.

Correspondence: Address correspondence to Dr Parker, 4600 N. Ravenswood, Chicago IL 60640. 773-561-7500.

From Advocate Illinois Masonic, Chicago, IL.

Copyright 2018 by Society of Teachers of Family Medicine