Guest post from Ahilan Sivaganesan, MD
Neurosurgery Resident Physician, Vanderbilt University Medical Center
The vast majority of physicians enter medicine with an inborn sense of compassion. Junior residents, however, are the logistical workhorses of teaching hospitals — their north star is efficiency and they are measured largely on their capacity to “get things done.” The consequence is often a slide towards unwitting apathy. I, like all residents, have witnessed this reality first-hand. By reflecting on my experiences, I hope to discover insights we can all use to take matters into our own hands.
The message reached my pager at 3:30 p.m. on a frigid, unforgiving December day: “31 year old male, motor vehicle crash, no movement arms/legs.” Bringing myself to within an inch of the man’s face I bellowed: “Sir, open your eyes!” No response. As clinically indicated, I then made a fist with my right hand and performed a sternal rub, digging my knuckles into his sternum with gritted teeth. Still no response. Then suddenly, the man spontaneously opened his eyes, looked frantically around the room, and then closed his eyes again.
Exasperated, I wondered, “What’s going on here?” Suddenly it hit me. I reviewed the patient’s scans and my fear was confirmed. Cervical spine injury and brainstem hemorrhage had rendered the patient “locked in.” Although fully alert, he was paralyzed from the neck down. Roving eyes were the only proof that a man still lived inside his lifeless body. He would be a prisoner unto himself. Fighting my instinct to stop and take stock of this tragedy with the man’s family, I rushed away to make preparations for surgery. Commiseration would have to wait.
The memory of this patient remains a splinter in my mind. The devastation — of a man’s life, of a family’s future — had passed by me that day as a mental footnote. I had fulfilled my obligations as a neurosurgery resident, but was there space for my full humanity?
A Resident’s View
“Doctor, Mrs. Anderson is in serious pain after surgery. She has morphine ordered, but it’s not cutting it.”
“Doctor, Mr. Johnson is asking to stay another day. He’s been discharged, but he doesn’t have a ride.”
During medical school, I would have pounced on these scenarios as opportunities for genuine doctoring. As a resident, however, they have become issues that need to be “handled” — new tasks for my to-do list. A patient’s inadequately controlled pain, then, is not the gnawing discomfort of a 40-year old mother of two, but rather a new un-checked box on my to-do list. A grandfather stranded in the hospital, with no transportation, means I have to keep an extra patient on our list.
How do I combat this plague of unwitting apathy? I start with mindfulness. Before entering any patient’s room I take a deep breath, mentally set aside all other looming tasks, and resolve to treat the interaction as an opportunity for true connection. It is a matter of being deliberate. I try to leave every interaction having learned at least one unique, personal fact — a reminder that a patient is not just a vessel for surgical pathology. What if the ubiquitous “patient list,” which all residents carry, were to incorporate these humanizing facts? Suddenly, bed 10 is no longer a “50yo M, post-op day 5 from aneurysm clipping,” he is a “50yo M with a son in Afghanistan who is post-op day 5 from aneurysm clipping.” Solutions such as this, which imbue our workflows with the fruits of rich patient interaction, may buffet a slide toward apathy. A system of credits, wherein patients can register their gratitude for caring residents, may also make a difference.
Ultimately, we must discern the various elements of a vibrant doctor-patient connection, and then weave triggers for those elements into residents’ daily activities. I will always remember walking into that spine-injured patient’s room the day after his surgery and noticing his college graduation photo pinned to the ICU monitor. Looking back and forth from his mangled face to the photo, I slowly realized that they were the same person. From that moment, that image — of a healthy, proud young man — was what came to mind whenever I thought of him. I began to see him the way his loved ones saw him, and I’m sure I provided more compassionate care because of it.
Is that not the standard to which we must aspire — to treat patients as if they were our loved ones? There is much a resident can be cynical about in healthcare. Much is out of our control. But how we relate to patients is a personal choice, and physicians can take simple steps to sustain the inborn compassion that drove them to medicine in the first place.