Room 618
Our training of physicians is imperfect. One certainty, however, is that internship and residency, that period of progressive, supervised responsibility, is the special sauce that can turn smart, eager, well-meaning medical school graduates into doctors. This is especially true for the resident who manages to stay mindful during the long, stressful hours.
Read Streller’s recent piece, The Arena, reminded me of both the pain and the value of residency training. Dr. Faerber’s reflection did the same.
Adam Cifu
It was my third visit that night, this one at around 6 a.m. – just an hour before my shift ended. On night float, I’d learned that you only see patients for problems. I simply didn’t have enough time to see every one of the 40+ patients I was covering. I was seeing MP, a 40-something-year-old female with metastatic cancer, admitted for pyelonephritis, who had had an acute hemoglobin drop during the afternoon that day, because her nurse had just identified the source: a large, bloody bowel movement.
For the intern, nights carry a unique level of freedom. I have an upper-level resident to lean on if I need (and even an attending if things get really out of hand), but most of the time I am flying free, making decisions on my own. This responsibility adds a mix of fear and excitement to the persistent fatigue. As I progressed through a month of nights, I began to appreciate its value. Growth occurs when you’re pushed outside your comfort zone and forced to make decisions on your own.
MP had already required two units of blood overnight, but luckily, she was stable for now. She was surprisingly calm as I glanced at the monitor to double-check her vitals. Her husband sat beside her; he hadn’t slept. During each of my visits, he peppered me with questions in his thick eastern Kentucky accent – attempting to prevent any errors in the chaos that ensues overnight. Now that she was stable, my work was to do all the small things to allow the day team to make quick progress after I handed her off. I shared my thoughts and outlined the plan. MP’s husband stood and extended his hand in a firm, genuine handshake. “Thank you, Doc.” It was the kind of handshake complete with a second hand resting on my upper arm.
Sure, I’d been a DO since medical school graduation, but I knew I was still growing into the weight that doctor carries. This was another of the many firsts of intern year. During the night, I had scanned my mind for the key management points of an acute GI bleed. Her husband hadn’t seen the racing thoughts – the quiet questioning and second-guessing. He was just appreciative because he knew that I cared. It wasn’t the knowledge or expertise. I was simply trying to give my best many hours into a long stretch of nights.
During one of the lowest months of my intern year, this handshake is memorable. A wave of positive energy to carry me through. The future physician I hope to become will be formed by time – by repetition, by mistakes, by growth I cannot accelerate. What remains fully within my control is who I choose to be in each encounter. I can choose to listen. To be present. To care. Because, without that, knowledge alone is empty.
Austin Faerber is an intern in the internal medicine residency at the University of Kentucky. Outside of medicine, he is a triathlete and lover of endurance sports.
Photo Credit: Navy Medicine
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Agree, You cannot always control the outcome, but you can control your effort and your attitude.
Austin
I loved this piece. It reflects not only excellent care, but excellent caring. You were present for both of their needs. The moment you describe—the quiet, wordless handshake from a husband who had just endured a night of fear—is something many of us recognize. Those are the moments that sustain a lifetime in medicine.
You wrote this in a column largely devoted to evidence-based medicine—the science of medicine—but what you experienced speaks to the art of medicine. Your presence clearly mattered to that suffering husband in a way that goes beyond EBM based protocols, algorithms, or guidelines.
From a scientific perspective, what you describe likely represented a moment of physiologic attunement: when two individuals come into alignment through shared neurophysiologic responses. There is growing experimental evidence that clinician–patient interactions can synchronize elements of autonomic and endocrine function—heart rate, heart-rate variability, respiration, skin conductance, cortisol, even salivary alpha-amylase. In other words, the connection you felt may have had a real biologic signature. This has been extensively studied in the world of placebo-nocebo science.
Unfortunately, this dimension of care is too often marginalized in today’s highly technical, efficiency-driven world of medical practice. Yet moments like the one you describe remind us why the human presence of the physician still matters so deeply.
As William Osler famously said, “Medicine is an art that uses science… but the art is much harder to acquire than the science.”
Kudos.
PS Your words made me genuinely happy to read. ( PS ask me sometime about my thoughts of being a DO and empathy.....)