Alumni鈥攆rom across the country鈥攕hare expressions of patient healing on a path towards empathy.
Edited by Jennifer Schaffer Leone
Rafael Campo, a celebrated physician-poet, has identified that, 鈥淓very interaction with a patient is in some sense a form of poetry.鈥�
In the five vignettes that follow, 黑料传送门 alumni
invite us into an empathetic space. They give a literary voice to their patients,
and subsequently reveal the sadness, hopelessness, and joyfulness of being a physician.
I met her as she sat at her daughter鈥檚 bedside. Although she looked as horrified,
disheveled, and confused as any family member I鈥檇 seen coming to terms with unexpected
loss and spending a night in the intensive care unit, I felt her expression grip my
soul. Her daughter was nearly a decade younger than me and鈥攁s she thought until that
day鈥攅merging from a past of drug use to a future of opportunity.
I couldn鈥檛 confirm for her why her daughter鈥檚 heart had stopped beating, even though she repeatedly asked me over the course of the following weeks. It may have been triggered by respiratory arrest associated with a severe asthma attack. Regardless of the cause, her daughter had diffuse anoxic brain injury and would never regain all of her prior faculties.
I watched the mother grieve, and I joined her on this path of many questions and not-as-many answers. Our morning encounters at the bedside invariably included a mixture of half-smiles and tears; a description of events at her home with the rest of her family in an attempt to maintain normalcy; and a commitment to give her daughter at least six months with a tracheostomy and PEG tube to declare herself and the full magnitude of her neurologic deficits before any discussions of withdrawing care. She demonstrated extraordinary hope to confront a challenging reality. I struggled with that reality and, internally, questioned whether her optimism subjected her daughter to greater pain than benefit if鈥攊n a not-so-distant future鈥攈er daughter might suffer from decubitus ulcers and recurrent urinary tract infections. She wouldn鈥檛 give up (and, seemingly, neither would her daughter).
I encountered her a few months after her daughter left the intensive care unit. The tracheostomy is now gone; her daughter appears to be smiling and, perhaps, laughing in response to familiar faces and conversation; and she found her daughter a residence at a skilled nursing facility with capacity for water therapy. I won鈥檛 forget her. I won鈥檛 forget the charge to merge realism and optimism into a realistic optimism.
John Raymond Dahdah, DO '13
Physician, Internal Medicine, Geisinger Medical Center, Danville, Pennsylvania
As a pediatric oncologist, when I reply to casual questions about what I do for a
living, I am accustomed to hearing responses like this:
鈥淲ow. That sounds so depressing. I could not even imagine!鈥�
Stomp, stomp, stomp! I鈥檓 sitting on the rolling stool in the exam room, playing hide-and-seek with a three-year-old boy dressed in his finest white cowboy boots and cowboy hat. He is smiling and giggling as he tries to hide from me behind the exam curtain. I can see his little feet moving up and down and hear his boots hit the tile floor. How can this be the tiny baby I knew with the sarcoma growing inside his cheek? He couldn鈥檛 eat because it affected his ability to suck. Failure to thrive, nasogastric feeds, central line infection, status post chemotherapy, 54 cGy of radiation鈥攜ou鈥檇 never know it today. Together, we are talking about preschool, futbol, and games of hide-and-seek. We are all smiling as we are bathed in the light of his joy. He is thriving. This is the farthest thing from depressing.
鈥淗ow can you possibly deal with kids dying?鈥�
I hate this. I don鈥檛 want to do this. I am filled with emotion as I walk up to the PICU to talk with his parents. The death talk, DNR/DNI decisions. Dread. This is the last thing I want to do at 7:30 p.m., after a long day in the hospital. This is the worst part of my job. 鈥淭hank you for being so honest with us,鈥� says his mom as she wipes tears from her eyes an hour later. We have both cried. His dad squeezes my hand. As I walk out, I take a deep breath and consider what a privilege it is to do this work. Remember, Kara: you are walking with people during the most difficult times in their lives. Be grateful. Be honored. Breathe in. Breathe out.
鈥淭hat must be the worst job in the world. How can you do that?鈥�
Ping. Another email hits my inbox. Some new task to attend to, no doubt. But wait鈥攖his is a name I haven鈥檛 seen for a while. My mind flashes back to her sitting in her hospital bed, wearing a hot pink wig, looking as sassy as ever. The room is covered with teen paraphernalia. She has been living here for the past six months. Throughout all the bad news鈥斺�渁cute myeloid leukemia,鈥� 鈥渘ot responding as well as we would like,鈥� 鈥渨e鈥檒l need more intense chemo,鈥� and bouts of nausea, rigors, fevers鈥攖here was, more often than not, a smile under that wig, and a desire to chat about her favorite nail polish color. I click on the email and am hit with a selfie鈥攁n image of a vibrant young woman in an urban park. Far from where I sit in sunny California, she reports, 鈥淒r. Davis, this is me in Washington Square. I鈥檓 doing a lot of yoga these days. I am almost through my first semester at NYU, and I am loving it. I feel great鈥攖hanks to you. I wouldn鈥檛 be here without you. Love, M.鈥� When people ask me how I can do this job, I answer that I can鈥檛 imagine doing anything else.
Kara L. Davis, DO '04
Pediatric Hematologist-Oncologist, Bass Center for Childhood Cancer and Blood Disorders,
Lucile Packard Children鈥檚 Hospital at Stanford, Stanford University School of Medicine
As a hospice and palliative care physician, I am afforded countless opportunities
to learn from my patients. There is true privilege in being present during a patient鈥檚
most vulnerable time in life, as one is allowed to bear witness to many extraordinary
and often selfless acts. Learning to be present with my patients during these times
has taught me much about what empathy means.
Hilde was in her 90s and had suffered a fall resulting in a hip fracture. I learned from hospice staff that she was a Holocaust survivor and that her name was among those on Schindler鈥檚 list. Given her life鈥檚 history, I entered the room with humble respect. She put me at ease with a gentle smile and, with her family, we discussed her goals. She was not a candidate for surgery, and she accepted this with grace. She declined steadily after this but lived her last days in comfort and with dignity. I visited her multiple times in the hospice unit before her passing, was reminded that the simple act of holding someone鈥檚 hand is often just as effective a therapy as a medicinal one.
I am always reminding myself that my patients all have their own stories, having sacrificed, loved, laughed and said goodbyes to their loved ones just as their grieving families do with them now. Sometimes, if I find a patient is alone and in their final days or hours, I will sit at their bedside to provide some kind of presence for them, hoping it is worth something. I think about the privilege it is to play even a small part in this person鈥檚 life journey, and often I will think of Hilde and thank her for that lesson.
Brendan Flynn, DO '00
Medical Director, Blue Ridge Hospice, Leesburg, Virginia
One of the attributes of being a 鈥済ood doctor鈥� that I learned as a resident was taking
time with my patients. As a junior resident, I often found this 鈥渆xtra鈥� time spent
explaining and educating not constructive to my growth as a physician. However, as
I grew in my discipline and became a private practitioner, I realized that this additional
time was beneficial not only for my patients, but also for me.
Recently, I saw Mrs. May, as I will call her, in consultation for postmenopausal bleeding. She was very nervous about seeing me because she had not seen a gynecologist in several years, and she felt that this one episode of vaginal bleeding was insignificant. After an ultrasound, I explained the need for an endometrial biopsy and possible surgery. During the procedure, she was tense and not easily distracted. Afterwards, she tearfully told me about having a similar surgical procedure for a miscarriage and being terrified of a cancer diagnosis.
I know God was with us at that moment. I grabbed her hands. We did not talk about the results or plans for follow-up. Instead, we talked about how good God was, how He never places us in situations that are too great for us, how we are victorious regardless of what we may face. Mrs. May told me she felt so much better afterward. But perhaps she did not know how much our encounter was a blessing to me. I do not talk about faith and spiritual beliefs with all of my patients, but I do recognize the impact that spiritual empathy plays in the lives of many who allow me to care for them.
Chavone Momon-Nelson, DO '05 MBA, FACOOG
Physician, Obstetrics and Gynecology, Carlisle OB/GYN and Carlisle Regional Medical
Center, Carlisle, Pennsylvania
I have been volunteering at the Women Against Abuse shelter at an undisclosed location in Philadelphia for the past eight years. I say 鈥渦ndisclosed鈥� because the women who are accepted to this shelter have passed an extensive lethality screening, a screening that determines a women鈥檚 risk of dying at the hands of their abuser. They are asked questions such as 鈥淗as he ever choked you?鈥� and 鈥淗as he ever had a weapon possession charge?鈥� Over 8,000 callers last year did not reach this level of danger and had to find other forms of shelter, which leaves only about 60 kids and their mothers occupying a temporary safe haven.
What the lethality review doesn鈥檛 take into account, but is implicit in each of the 20 questions it asks, is the effects on the children who see, hear, feel, sense, the dangers in their home, the place that is supposed to protect them, to shelter them from evils and fears outside, not within.
Will (not his name) was 13 at the time, the same age as my middle daughter. He and his mother stood out immediately. Reserved, quietly awaiting their turn to see the doctor on our monthly 鈥淒octor鈥檚 Night,鈥� he had his face in a book, oblivious to the frenetic children running around, climbing on chairs, begging for attention. Will really didn鈥檛 have any medical issues, but his mom wanted him to get 鈥渃hecked out.鈥� His past medical history and physical exam were perfect, but my knowledge of how early childhood trauma adversely affects the developing body and mind did not reassure me that all would be well. I asked about his favorite author. 鈥淩ick Riordan,鈥� he said without hesitation. 鈥淭he Percy Jackson Series,鈥� he blurted out. These were my daughter鈥檚 favorites as well; she had recently met the author and had a signed copy of his latest book. I asked Will if he would like me to bring back a few books in the series that he hadn鈥檛 read yet, and he agreed, not as excitedly as I would have thought鈥攂ut then I remembered the empty promises that so many of the children we care for here must have heard over the years. I told him I would come back in the morning, before school, with the books. He looked at the floor for several seconds, then looked up at me with his light brown eyes that had seen more than any child should, and walked away.
The next morning, I signed in at the security desk of the shelter and had the guard call Will鈥檚 room. My daughter, having heard his story, had given me the signed book to give to him. As I waited for Will to come down, I watched as child after child signed out to go to school, some in donated clothes that I recognized from our clothes drive, some with backpacks filled with homework and the secrets of living in a domestic violence shelter that each one of these children brings to school each day.
Will finally came down with his mother and, this time, looked deeply into my eyes, saying without a word that I had not let him down. I gave him the signed book as well as a few more, and he immediately went back into the trance from when I first met him, book in hand, transported to a fantasy place where children his age had immense powers and were heroic. He opened the signed copy last, and traced his forefinger over the signature from the author as if he were signing it himself.
鈥淭hanks,鈥� he said, as he prepared to go to school. 鈥淜eep this safe,鈥� he said to his mother as he gave her the signed copy. 鈥淚 promise,鈥� his mother said, as she kissed him goodbye, and tucked the books under her protective wing. I stood there motionless as they walked in separate directions, the security guard my only companion, both of us knowing that we were in the presence of young heroes and their mothers, who will hopefully, someday, be safe.
Daniel R. Taylor, DO '97, FAAP, FACOP
Associate Professor, Drexel University College of Medicine, and Director, Community
Pediatrics and Child Advocacy, St. Christopher鈥檚 Hospital for Children, Philadelphia,
Pennsylvania