I guess it happens to everyone, I thought to myself as I sat in the cold molded plastic chair belonging to the Labor and Delivery office. The night shift, weary from late night deliveries and magnesium checks had just come in to give morning sign-off. The morning attending ran through the door, scrubs askew and pager in hand, and asked for a quick update. “The woman with dizygotic dichorionic twins is doing well, the mother who just gave birth is resting soundly . . . and then there is the patient in Room 1.” A synchronous harmonic groan protruded from the oral cavities of nearly everyone in the room.
I was always confused by the term jaded. For many years, I thought of jade as a cultural term for a durable beautiful gemstone used by craftsmen of an ancient world. It was only later in life, more specifically while completing this essay, that I came to learn that this word’s origin is a description of an overworked horse.
The idea that medical students evolve from open minded, kindhearted learners into blunted hardened residents is not something new. Article after article has spoken on this phenomenon. The fact that satirical blogs address this issue should erase any doubt of its legitimacy. In sessions on navigating challenging patient encounters, we discussed matching our patient’s emotional level and validating their feelings. This all sounds well and good, but if you asked me what I saw on the wards, it was sometimes something else altogether. Instead of true empathy, what I saw was tolerance with a dash of apathy. A subtle, “I’m so sorry,” delivered while eyes continued to be glued to the computer screen. A couple of head nods masking glances up to the clock on the wall. A few generalized niceties after a knock on the door followed by a barrage of negativity in corridors and in offices once the door had clicked shut.
If I told my first-year self that these sorts of things happened, he would be shocked. He would throw up his arms and demand change. However, to third year me, it made sense. No longer was medical care as simple as filling bubble C over D. No longer were patients without knowledge, opinion, opposition, penury and real tangible audible suffering. Combined with long hours, piling debt, a broken healthcare system and the fear of litigation… it’s no wonder medical students lose empathy. How could we not?
I guess it happens to everyone, I thought as I caught myself joining the groaning chorus. The patient in Room 1 had been, to use a word we are taught not to use in notes, difficult. She was more than a week post-op with poor pain control issues, a high DVT risk, and a strong desire not to move from the supine position she laid in. I saw this patient when she came in and I noticed sympathy decrease as her problem list lengthened. Sign-off to sign-off, her reputation and infamy grew. Soon providers who had never seen this patient joined in on the muttering and complaints when her name arose in end of shift conversations. I even remember one provider questioning her capability to take care of the child she recently bore.
This is the part of the story where I tell you about how I saw her over the course a week and I built a rapport. I mention how it began with simple facial reignition but then transitioned into back and forth questioning about heritage, family and the people we have at home. It incorporates a point of alliance, a story of her addiction to heroin and a proud reveal that she quit cold turkey five years ago prior to the birth of her first child.
However, the reality is that I had ended up a groaner too.
I truly believe that all providers start as extremely sensible, kind and compassionate people. Yet, like a young thoroughbred foal, we get saddled and bridled and adjusted to human weight. Over time our speed slows, our stamina wanes and a scary reality develops where we are destined to break down. However, I cannot think this way. I have to believe that we can become more than an overworked horse.