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Grappling with Death, Becoming a More Caring Doctor

 

“And we just went on to the next room as if nothing had happened.”

Julie sat in the circle in green scrubs.  She spoke in a monotone, her eyes focused above and beyond those of us listening.   She seemed so unlike the girl with the contagious laughter who had buoyed our conversation moments ago.

Julie was one of ten students assigned to my PDC (Patients, Doctors and Communities) class that meets monthly during the third year of medical school.  The third year is a time when students move from the familiar tidiness of the classroom to the frenetic pace of the hospital wards where they have their first real involvement with patient responsibility.  It is almost always an overwhelming, sometimes a brutal confrontation with the harsh realities of public health care.   Textbooks are clear, focused, neat and comprehensible; but life in the world of disease and pain can only be described as messy, and sometimes debilitating to the student.

Einstein introduced the PDC class eight years ago, recognizing that the third year is pivotal in the formation of a doctor’s professional identity—a time when ideals are integrated or lost and when a student’s dreams of delivering compassionate care can be in peril.

There are other nodal experiences in the physician’s education, such as the cadaver dissection in first-year Anatomy and the physical examination course.  Sometimes the emotional challenges of learning medicine can prompt a student doctor to wall off feelings in order to do the job.  Managing intense feelings is necessary for the work of doctoring; but simply blocking them off can depersonalize both doctor and patient.  An emotionless doctor cannot master the art of healing.

Julie’s remarks came during the second class of PDC after she had spent a month on the medicine wards.  A patient her team had been caring for died shortly before they were scheduled to meet with the woman during rounds.  “I hardly knew her,” Julie said, “but she had just died and we went on as if nothing had happened.”

Rob Angert, my co-facilitator in the group, invited Julie to stay after class ended, and she confessed tearfully to us that she was finding death unexpectedly disturbing.  She assured us, however, that she was committed to learning to handle the feelings; her wish to become a doctor was deeply held and lifelong. Rob and I gave her our cell numbers and encouraged her to call if she wanted to talk.

At next month’s class Julie spoke again. She told us that she was gradually learning to deal with the experience of a patient’s death.  One of her attendings even took some time at rounds to discuss everyone’s feelings after a patient died unexpectedly.  As our PDC class continued through the academic year, Julie became one of the members who showed the most sensitivity to feelings, both her own and those of the other group members.

Two years later, a colleague told me that Julie had applied to his residency program and had spoken of our PDC class.  Each of the faculty who interviewed found her an exceptional candidate.

“Something special about her, her presentation,” he said.  “No, maybe her presence—she was really all there.”

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Lawrence Dyche, M.S.W.

Lawrence Dyche, M.S.W.

Lawrence Dyche, M.S.W. is assistant professor, Department of Family and Social Medicine at Albert Einstein College of Medicine.

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