The Emotional Backstop

Posted on TDWI July 30, 2012

I read a very poignant story in the Weekend Wall St. Journal a couple of months ago. It was about Specialist Keith Benson, a dedicated medic in Afghanistan who had discovered his calling in the Army, marrying his love of medicine and his desire to help people with his perfectionist “zeal,” as the writer, Michael Phillips, put it.

Phillips chronicled Benson’s efforts to save a comrade who was fatally injured in an enemy attack. Benson revived him in the field under battle conditions three times, and kept him alive for over an hour until he was helicoptered out. Benson was devastated that, ultimately, he could not save his friend’s life. It was Benson’s first battlefield casualty, and his distress haunted him until he took his own life.

The story underscores how powerfully health professionals are affected by patients’ lives — and their deaths. It also emphasizes how the professional medicine infrastructure provides us the critical backstop we need when we question our own skills and judgment. As dangerous as it is to get emotionally invested in patients, they have so much to teach us.

Powerful interactions with patients can be devastating and self-affirming. Frankly, the devastating experiences seem to leave the biggest impact; most of us believe we are not supposed to fail. Early in my career, I believed that too. But once I accepted that people are going to die and that I couldn’t save everyone, I began to look for what every life was trying to teach me.

I am not trying to be a Pollyanna. Ask any physician you respect to describe the three patients who have made the greatest impact on them, and how those patients shaped who they became as physicians. It probably won’t take long for them to answer. For me, it was these three:

HS, an 80-year-old woman who lived on a chicken farm in rural Orangeburg County, SC, was admitted for pneumonia that rapidly progressed to acute respiratory distress syndrome. She was intubated and gradually became unresponsive while she was ventilated in the ICU. I was a 4th-year student. I held HS’s hand, spoke to her, and watched attending physicians talk around her as if she weren’t there. She had said that if she could not go back to tending her chickens, she would rather be dead. When she died, I was acutely aware that we had only extended her suffering.

DZ, a 5-year-old-girl who was run over by a school bus in an unmonitored elementary school parking lot. Her papers blew under the wheels of the bus and as she scrambled for them, an 18-year-old driver backed over her. She was awake in the ER and I saw the terror on her face. She survived the first surgery and was stable until she had a fatal arrhythmia in the pediatric ICU. I raced up there with the code beeper and was part of the team that tried everything to save her, without success.

MS, the 80-year-old high school teacher from Charleston, SC, who had horrible emphysema and a benign high-thoracic tumor compressing her spinal cord and causing progressive weakness. In spite of everyone’s concerns that she would never get off the ventilator post-op, she said, “I don’t want to live this way. I would rather die in surgery.”

We devised a creative anesthetic technique together. She agreed to an “awake” intubation and an IV anesthetic that would allow her to maintain own respiratory effort. We performed the surgery in the sitting position to minimize the perioperative pulmonary changes. She was extubated at the end of the case and went home three days later.

What did these three lives teach me?

HS made me realize that “quality of life” should be determined from the patient’s perspective. She made me think that there is a right way and a wrong way to die. DZ taught me how you can feel pain for the injustice of the situation. You can be a professional and still be very human. Our humanity is what makes us great physicians.

MS taught me courage, that everything can be considered as long as it is done with consideration for the patient.

I met these patients when I was young and new in my career. The failures did not destroy me because of the infrastructure of medicine. Our culture is not perfect, but it is supportive. Part of the journey as a physician is sharing the experiences with your colleagues—the professional victories and failures. Unfortunately, Specialist Benson did not have the same infrastructure to help him with his sense of failure and loss.

—Joanne Conroy, MD, is Chief Health Care Officer at the Association of American Medical Colleges. She can be reached at jconroy@aamc.org. Follow her on Twitter @joanneconroymd

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  1. Pingback: My Three Patients | WhiteCoat's Call Room

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