Today's attention:
A medical student who admires the attending physician's composure and control of the patient's rescue of the patient, but the attending physician knows that all this is a superficial illusion necessary to move herself and her patients forward, but in fact her heart is full of fear and uneasiness, and she does not know whether to tell the medical student these truths and share the fear and vulnerability, or to maintain the illusion and support the medical student to move on.
Erica Andrist, a physician in the pediatric intensive care unit at Mott Children's Hospital at the University of Michigan, thought about this question in the New England Journal of Medicine (NEJM).
"I'm not interested in intensive care," one medical student expressed his thoughts without malice. Today was his last day of rotation in the intensive care unit, and we took the elevator to the lobby together. "But I admire your work, and your rescue is amazing. ”
I was pleasantly surprised by his compliments, especially since I could tell he was genuine. My mind immediately returned to my days as a medical student.
I freaked out when I learned that I had been randomized to the Children's Intensive Care Unit (PICU) for a third-year pediatric inpatient rotation. The PICU is where there will be a child who dies. I'm not sure I'm smart enough, and I'm not sure I'm strong enough. But unexpectedly, I found that I seemed to enjoy working here.
But then one day, one of my patients passed away.
I remember staring at the attending physician standing at the foot of the bed. She takes the chaos around her with her stride and is amazed at how much she controls the big picture. It's like she can foresee what's going to happen and react before it happens. I still remember the tenderness and sincerity with which she finally turned to the patient's family and said "condolences".
I was amazed by the medical student's words. The attending physician I saw many years ago is exactly the same as I am today. My medical training was like a circle: from the corner of the ward, to the bedside, then to the head of the bed, then to the foot of the bed, and finally briefly back to the corner of the room. The past is vivid in my mind, and I can't help but be amazed.
What I didn't tell the medical student was that I now understood that this sense of control was very much an illusion, a complex magic trick, and that what was hidden underneath was our panic, our sadness, and our incessant inner prayers for whoever we prayed for, whatever we prayed for, as long as the other person was listening. What I didn't tell him was that the truth behind the illusion of everything under control was that even if you got everything right, you could still fail.
Of course, we do have great power, and it was our glorious moment to fight death and return the children to their families almost unscathed. I didn't tell the medical student, and I understood why some doctors had a God complex. There are children in this world who survive because of a decision I made. Parents tearfully thanked me for saving their children's lives. Sometimes I know their children are never really on the verge of death, but parents still say that.
How do I respond to such a heartfelt gratitude?
I didn't tell the medical student that I knew I was saving lives for a living, and I knew I was making life-or-death decisions in my day-to-day work, which was true, but I couldn't allow myself to think like that. These facts are like Medusa's face, like the sun during a solar eclipse, and the consequences of staring at them are unimaginable. I am still unable to fully bear the weight of these facts.
I didn't tell the medical student that I was still afraid of using this power, and even more afraid that it would hurt if I didn't use it well.
I was reminded of another resuscitation, which was in my first year as an attending physician, a female high school student with severe septic shock who developed ventricular tachycardia due to heavy use of catecholamines. It was just me and two other people who were involved in the rescue, and for what reason, I don't remember. The nurse was very capable and did the work of three people by herself. Another colleague who was involved in the rescue was also a newly attending physician, and his eyes were as wide as mine, and he was responsible for charging the defibrillator. It seems to me that we clumsily completed this rescue with little manpower and inexperience, but we succeeded in constructing this illusion. But I knew that the illusion was a success, because the girl's mother later approached my mother on social media and told her, "Dr. Erica is in control." "We returned the patient to her family's arms almost unscathed.
The patient was later admitted to Michigan State University, where her dormitory was attacked by gunmen last year. I didn't tell the medical student that in the darkest moments of my life, I wondered if I had actually helped any child, and that I had saved the girl's life, but had actually sent her back to this violent world of anger, guns, and infectious diseases created by adults. I didn't tell the medical student that if it was long enough, death would win.
I didn't tell the medical student, I used to tell my colleagues that it would all get easier to accept, but it would never be easy. I spent a lot of time training, and I hope that one day I will become a senior doctor, an attending physician, and an attending physician with a few years of experience, and I will no longer be afraid. The anxiety and burden in the heart will be lightened. But this sense of peace of mind never came, and I wanted to know what was wrong with me, how I could be such an embarrassed loser, and why I always felt guilty instead of being full of talent.
I didn't tell the medical student, and I now think it would be a pathology not to be afraid of losing a child.
What if I told that medical student? What if we revealed the real person behind the illusion to each other and to ourselves? Would we share our shared fears and vulnerabilities and support each other? Who would be better able to take care of the people we should care for after questioning the reality and illusion of our control? Will he be better prepared for the hard training and career that lies ahead?
Still, I will break the illusion that is necessary to continue this work, because it is this illusion that promises us that we will one day be in control and fearless, and this promise is not true, but it is sustaining us forward. Perhaps our patients also need to believe in this illusion, at least some of the time.
I don't have any answers to these questions. At this point, the elevator door slowly opens.
"Thank you," I said as he stepped out of the elevator, "and it's great to hear you say you had a great time here." ”
