medicine · MS-3 · narrative medicine

I’ve been debating for a long time whether or not I should write about this. But the issue’s come up over and over, and I keep dancing around it, and then I blurted it out on the phone, so then I figured, what the hell.

So I had this patient…

It was more than a year ago. My  medicine rotation. Saturday. I picked up an overnight admission that my resident described as “interesting.” I’ll spare you the details of the case, except to say that this man was pretty healthy when he came in (“because his sister insisted”) and then turned into an avalanche.

The actual moments of his medical care are like a series of snapshots in my head. I remember his teeth, very white, and his skin, very orange. And his hct dropping precipitously, and the team rushing down the stairs to find him in the echo suite to try to DNR/DNI him. And the way he blew up in spongey anasarca, and the incongruity of my favorite purple cowl-neck sweater dress (because I had a date straight after work) with the task of placing a Foley. And the family meeting to discuss hospice, and his brother who looked very like him, a little overweight in an overly tight screenprinted T-shirt and dark blue baseball hat.

Anyway, the reason why I bring this up, and the reason why I hesitated, was that my response to all this was … less than ideal. I grieved intensely for this man; we all did. There was such a sense of depression when we’d talk about this patient on rounds — everyone would look down, slouch, try to pretend this wasn’t happening.

And we never spoke about it. Ever. I remember sitting on the couch, not actually watching TV. I remember running into a friend in the library who, when I apologized for being so distracted because I was worried about my patient, said “Well, you’ll need to get over that if you want to be a good doctor.” I remember my resident — a man whom I liked and respected both as a person and a physician — sighing one evening at the computer, saying he’d spent the month going through a bottle of Scotch.

It was this last that really got to me. Because this was a great resident, and the implication for me was that the appropriate way to deal with grief was to get … well, not drunk, not wasted because tomorrow is another work day, but at least a little numb. I don’t like Scotch, because I am a girly girl, but there was a wine store newly opened a couple of blocks away, and I bought three or four bottles, different types, all cheap. I paid cash and told the cashier it was for a party. I don’t think I drank excessively (but isn’t that what they all say?) but definitely every day. A glass. Sometimes two.

And then at some point, after this man had gone to hospice, I realized this was a terrible way to deal with crap. It wasn’t helping my mood, because even though the alcohol helped me go to sleep, I’d wake up the next morning feeling just as rotten about this man’s decline, and I wasn’t doing so hot on the shelf practice questions either. But I didn’t know what else to do, in part because the responses I saw from people around me was “The way to deal with bad stuff, personal and professional, is with alcohol.” (Obviously, not everyone deals with burnout this way. Lots of physicians are happy well-adjusted people. Or at least they hide it better.)

This man’s dying, or more accurately my horrible response to it, was what finally convinced me to send in the Narrative Medicine application I’d been sitting on for over a month. I needed something in my toolkit to move me past the message I got from my friends and from the hidden curriculum. I needed death without cirrhosis.

I finally found the space to write about this man, and not in a didactic “I learned an Important Life Lesson (TM)” way. It was painful, again, but in a different way, because it had been so long and felt more like a movie than a real event. But as soon as the ink was on the page (I write in longhand, because I’m an old lady), some switch flipped in me and I became a writer again. The words were this separate entity, and I could move them around, change them, rhyme them or not. I had choice, control, authority, not over this man’s death, but over this text and therefore my response to the death. For instance, did I want to address him directly (“your skin with its orangeish sheen”) or not (“his skin” etc.)? How did that choice affect the poem as a whole? And somewhere in all that crafting, his death stopped being painful. It still doesn’t make sense to me, but the poem makes sense as itself, and sometimes that’s the best we can do.

If I’d written about that man a year ago? Maybe it would have helped me. I’ve never been a fan of “let’s talk about it”(except with my mom), because medicine is still very macho and sharing emotions is for the weak or hippy, but the written word is where it’s at for me. There’s something about those squiggly marks on paper that makes them manageable. Maybe if I’d had the mental and emotional space (always a challenge during rotations), or at least the encouragement and/or self-confidence to write, I could have avoided my brush with alcoholism. Maybe not. But I should have tried.

Today is the first time I’ve talked about this, with anyone. My friends were aware, at the time, of how upset I was, but no one intervened. I mean, they hugged me and told me things would be alright, but no one suggested I try something other than alcohol. I don’t think they knew; even those who were supportive didn’t ask what I was doing to cope. I’ve seen friends self-medicate, before and since, and I haven’t said anything either. Not my place. But I’m incredibly grateful for the opportunities I’ve had this year to find alternative ways of dealing with the crap that I know will happen. I don’t want to drink myself into numbness again.

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5 thoughts on “

  1. thank you for sharing. i have my list of patients that i think about all the time, and thank goodness for my wonderful boyfriend, because i talk out some of the scenarios to him and it does help me feel better. writing and exercising is also cathartic for me as well. i just have to agree that keeping it all inside doesn’t help.

    1. Thanks. You’re right — there definitely is a list of patients that just hit you for whatever reason, and they stick with you. And support from loved ones is key; I just feel really weird talking about patients with people not in medicine (but apparently I’m ok talking about it on the internet?)

  2. THANK YOU FOR WRITING THIS.

    As a (hopefully/soon to be/zOmg!StepOne1!!1!) third year, I’m grateful to be able to read your post. At my most naive, I want to believe that this could and would never happen to me. I know that I should know better.

    I don’t like narrative writing. Problem is that the alternatives come in bottles or cartons, or worse (as you discovered).

    Keep writing. Publish when you’re ready. Take us with you.

    1. Thanks! And it’s great that you’re thinking about this issue, and what to do, already. Our school did a very sentimental lecture on “breaking bad news” in second year, but that was it; everyone ends up figuring it out on their own. So much of the way we deal with death is person-specific — one of my friends paints these amazing abstract artworks, another cooks like she’s on Iron Chef, I write … the trick is finding something (healthy) that works for you.

      Best of luck with Step 1! It feels like a Jabberwock at the time, but trust me, by the time scores come out you’ll have almost stopped caring.

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