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When doctors don’t have enough to give

Every time I walk into a bookstore, I pass Paul Kalanithi’s When Breath Becomes Air and am reminded of a specific anecdote he shared. Kalanithi, MD, was a seventh-year neurosurgery resident and his lung cancer had metastasized – a process which was only being controlled by a new drug his oncologist had decided to try. But one day, Kalanithi had severe nausea and had to be hospitalized to stay hydrated. A second-year internal medicine resident (five years Kalanithi's junior in training) was in charge of his care, and he decided to take Kalanithi off his cancer drug because it might be causing damage to his liver. When Kalanithi argued with him that this was unlikely since he had been taking it for a year, and that without taking it a bone-searing pain would set in, the resident responded: “If you weren’t you, we wouldn’t even be having this conversation. I’d just stop the drug and make you prove it causes all this pain.”

I still think about this hurtful interaction and marvel over both the insensitivity of the medicine resident and the grace of Kalanithi to forgive him. (In writing his memoir, Kalanithi chose not to name the resident because he didn't want this physician's career to be defined by one moment of irritability toward a patient.) It takes an incredibly self-empowered patient to have a doctor say something hurtful or insensitive and forgive them because as patients we are so vulnerable and so trusting of our doctors.

I thought of Kalanithi again when I read a piece in the New England Journal of Medicine earlier this year. In her piece, called “A View from the Edge – Creating a Culture of Caring,” Rana Awdish, MD, tells the story of how she became fatally ill while seven months pregnant and practicing medicine. She had to be hospitalized and nearly died several times; her unborn baby did not survive.

Awdish writes about how devastated she was as a patient by insensitive questions and comments from doctors -- questions and comments she herself might have made if she had been the treating doctor. She also shares stories of how the staff went out of their way to treat her with kindness – acts which in themselves helped her heal. For example, a transporter saw her break down with grief over her lost child when a radiologist asked her about the small pink baby bracelet still in her chart. So this transporter took it upon himself to tell the technicians not to ask about the baby, and word spread to other staff members such that “in an 800-bed hospital, the transporters had united to form a protective enclosure around one patient.”

Tears filled my eyes as I read this story of how empowered staff members can give the kindness that sometimes tired doctors can't give, and of how empowered patients can forgive doctors for their flaws. But mostly, these stories motivated me to be the kind of doctor who can – maybe, sometimes – be aware of when I lack empathy and ask for help. After all, medicine is teamwork and caring for our patients can come from many people when one of us is too run down. This isn't at all an excuse for doctors to be unkind but rather an acknowledgement that we will inevitably make mistakes because we are also human. And rather than chastising ourselves, we should learn to identify when we lack emotional energy and seek creative solutions so that our patients don't feel a cold gap.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Natalia Birgisson is a fourth-year medical student at Stanford. She is in her second year off and writing her first novel, which is described on her site

Photo by vargaz

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