By Lauren Van Scoy
As medical students and residents age in the process of their careers, a certain innocence is lost. As responsibility increases, time at the bedside paradoxically decreases. As young physicians are plunged into the grueling routines and realities of being a busy practicing physician, many lose their connections to the very people that are the core of their work: their patients.
I am a senior pulmonary and critical care fellow and often am responsible for 25 or more critically ill patients during my shifts. Each patient and their families have important stories to tell.
I was fortunate that my medical school had an outstanding curriculum in physician and patient interactions, with valuable lectures and weekly small group discussions about issues such as communication skills, death and dying, and coping with grief. Yet it wasn’t until meeting Bill, and the ensuing relationship in the years following our acquaintance, that my understanding of critical illness changed. My curiosity about his medical case allowed me to discover the value of narrative medicine to my growth as a physician.
I met Bill when I was in my youngest physician form, an intern rotating the critical care unit (CCU). He was near-death, on full life support, after a highly resistant infection invaded his chest cavity, threatening the vitality of the left ventricular assist device (LVAD) that was implanted into his heart, mechanically pumping blood through his body. He was sedated, comatose, and had very little hope of a full recovery. At one point he coded, requiring medications and CPR to revive his arrested heart.
As an intern, I saw a horizontal patient in a hospital bed, under the being assault of modern medicine. After I completed my month long CCU, Bill continued to undergo incredibly aggressive care, and despite the noble attempts by his physicians, I would have guessed that Bill was certainly dead.
It wasn’t until over a year later, when I was back rotating in the CCU, that I was shocked to see Bill’s name on my patient list. After reading the chart of his amazing recovery and his life saving heart transplant, I went to see him in his room. Instead of a horizontal patient connected to machines, I now saw a vertical man, sitting upright and eating breakfast. After hearing his story, I was inspired to write about my misconceptions about his chance of survival, my growth as a physician and Bill’s journey through critical illness.
His story teaches important lessons about prognostication, care coordination, caregiver burden, spirituality and the patient experience. Had I not spent the time to learn more about Bill, his family and his struggles through the process of narrative writing, I would not have experienced the richness of what his case has to teach, both medically and and humanistically.
Reflective writing isn’t for everyone, but certainly, it is something that should be introduced to anyone pursuing a profession in health care. Whether writing for personal use or for publication, the growth that narrative writing enables is an invaluable resource for any healthcare provider searching to become a more well-rounded clinician. Still, going a step further, and reaching out to a patient or family and asking them to share their personal story and experiences allows more than simple self-reflection. Sharing stories between patient and physician allows a deeper and more meaningful understanding of the patient experience and a tighter grasp of the patient connection that we felt and valued as medical students.
Video reposted with permission from the author.
– Lauren VanScoy, MD is a chief pulmonary/critical care fellow and end-of-life researcher in Philadelphia, PA. She is author of the book “Last Wish- Stories to Inspire a Peaceful Passing” as well as several other narrative writing projects. She can be reached at firstname.lastname@example.org.