SMS (“Stanford Medical School”) Unplugged was recently launched as a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.
I woke up gasping for breath. My patients had died, and I was dying with them. Gradually, my mind unclouded and I realized that it had been a dream, but that realization didn’t soothe my worries. I lay in bed wide awake, anxious. I was picturing the woman who couldn’t speak due to a stroke, who squeezed my hand and raised her eyebrows urgently, asking me for something I couldn’t identify. Then I was remembering the very sick elderly man whose wife brought homemade soup to the hospital every day, and who always had a warm smile and a flurry of gratitude in Mandarin for anyone who entered his room. Their faces swam through my mind for a long time before I returned to sleep.
I was in the midst of my first clinical rotation. After two years focusing on the basic science of medicine, finally caring for actual patients was exhilarating and all-consuming. Even after long days in the hospital obsessing over what else I could do for my patients, I would talk about my clinical experiences on the phone with my mom, on runs with my friends, and over dinner with my husband. I lived and breathed my new role so completely that in my dreams, my patients’ deaths were synonymous with my own.
Now, two years later, I still love my days spent caring for patients in the hospital and clinic, but I don’t dream about my patients anymore. I rarely talk about my work over dinner. This wasn’t a purposeful change, and sometimes I wonder if it means I care less than I once did. I worry that I am Exhibit A for the predictable erosion of empathy that we're all told to expect by the time we graduate from medical school.
In my more self-forgiving moments, I tell myself this change in how I experience patient care means that I'm learning to compartmentalize my experiences to survive the many emotionally demanding years ahead of me in the medical profession. Based on what I hear in the periodic group reflection sessions that we have in medical school, many students, as well as senior physicians, agree that this kind of compartmentalizing is the key to avoiding burnout. After all, being completely present for the patient sitting in the room with me means learning to put aside other concerns - including thoughts about my other patients. The same goes for my ability to be present in the rest of my life as a wife, mother, or friend. However, in spite of all this, there is still a part of me that wonders if my growing ability to mentally put my patients’ problems aside will translate into a decline in empathy and passion for my work. After all, I didn’t come to medical school just to survive it - I came to medical school because I believed caring for patients was my calling. What does it say about me that I can so easily leave that passion at the door of the hospital?
In the end, however, I remind myself that the mentors I admire the most for their empathy certainly aren’t the ones who worry about their patients the most. They are the ones who go beyond what is required and do something meaningful for their patients. I think of the pediatrics resident who spent hours on his night shifts playing games with a lonely patient when he could have been getting some sleep, or the attending who made a home visit after an already long day of clinic because she thought her patient needed more help getting his medications organized. I admire these doctors for the remarkable compassion they show while they are on the job, not for whether they're thinking about their patients once they go home for the day. Having nightmares about my patients may have showed that I “care” on one level, but that is a shallow and lonely kind of caring compared to channeling those feelings by doing something extra for my patients. If I had continued the worrying I was doing in my off hours, it would have eventually worn me down without ever doing my patients any good.
So as for the famous erosion of empathy that occurs during medical school, I'm beginning to suspect that it isn’t so much an erosion as a polishing. To some extent, my experience of medical training is sure to polish away some of the more self-oriented manifestations of empathy: the constant thoughts of my patients during off-hours, the desire to talk to my family about my experiences caring for patients, or the strong emotional and visceral reaction I feel upon being confronted with another person’s suffering. All of those things may fade or change, but what I hope remains and grows stronger throughout my career is the passion for being present with the patient in front of me, and doing whatever it takes to meet his or her needs.
Jennifer DeCoste-Lopez is a final-year Stanford medical student applying to residency in pediatrics this year. She was born and raised in Kentucky and went to college at Harvard. She currently splits her time between clinical rotations, developing a new curriculum in end-of-life care, and caring for her young daughter.
Photo by Elba Fernandez