Insight, I believe, refers to the depth of understanding that comes by setting experiences, yours and mine, familiar and exotic, new and old, side by side, learning by letting them speak to one another.
-Mary Catherine Bateson
Last week, a group of third-year medical students completed their first rotations through Surgery. They spent eight weeks doing things that no normal person would ever be asked to do. Many days, these students arrived at the hospital at 5:30 a.m. to begin 30-hour shifts seeing patients, checking laboratory reports, making rounds, and observing surgery.
In the operating room, these students saw, heard, and experienced many unthinkable things for the first time. They held retractors for hours. They felt the warmth of another person’s intestines envelop their hand and forearm as they listened to the surgeon describe findings deep in the belly. They watched as a heart resumed beating after bypass or transplant surgery.
The students also spent time talking to patients and learning their stories. Many of the students were present as a person that they had gotten to know died.
When I was in medical school, the end of the surgical rotation meant merely that it was time to move on to the next, certainly less intense, clinical experience.
For this group of students, though, their teachers planned something different.
These students were offered the opportunity to prepare a creative piece to reflect on what they had just experienced. Almost half chose to write a poem, create an essay, or paint a picture.
This was not your standard bookshop reading! There were poems about bowel movements and horrific odors. There were pieces about cardiac arrests. There were appreciations of patients’ stories. There were evocative poems about sick children. Some of the pieces were very funny, some displayed great tenderness. Many of the students admitted that this was their first attempt at reflective writing or verse, yet all of the pieces reflected their shared immersion in a rich, vast, and powerful experience.
When the session ended, all of the participants and their classmates sat stunned. As one later shared, “I've experienced many emotional moments throughout the past two months and it wasn't until this hour did I finally have time to realize and reflect on my personal experiences and their impact on my life.”
Importantly, one student wrote, “I learned that perhaps I do need to put some effort into maintaining empathy.”
Medical school involves thousands of hours of instruction. This was unique. This was a single, planned, intentional hour of reflection.
Perhaps none of these particular students will go into a surgical field, and that is just fine, yet I hope that one of them becomes my own physician when the time comes. Having heard them read and reflect, I know that I will be in good hands.
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Interesting post. It takes a special person to want to go through all that. Has to be a calling! certainly... most people could not withstand the rigors of a medical education.
I never realized how empathetic doctors are toward their patients until I joined the med blogosphere. I'm glad to know they are. :)
I thought surgeons weren't supposed to have feelings though. ? That they were supposed to be the non-feeling specialty? generally speaking.
Thanks for the comment! "Surgeons weren't supposed to have feelings"!?! Ouch! Occasionally, a little empathy slips out!
Actually, a research study a few years ago confirmed that medical students that have higher empathy scores are more likely to go into primary care specialties, so I guess you are on the right track.
It's not that we don't have emotions, or are not caring; its that we have learned to suppress our emotions in order to perform the incredible tasks that are required of us. If a surgeons hand slips, or his concentration wavers, even for a second, while performing a routine operation, loss of life can ensue. Procedures tends to be much more routine and methodical when you have the distance separating you from what you are actually doing. It is this ability that makes us successful as surgeons. I would hate to have an overly emotional, frantic surgeon's hands in my abdomen while I was bleeding out.
- Steven Savage
Dear Dr. Savage,
Thanks for your comments. What you say strikes at the heart of one argument I have heard about the ACGME's core competencies for residents. A resident can excel in all of the competencies and still be technically dangerous surgeon.
Still, I don't think that a side effect of including reflective or narrative experiences in a Surgery clerkship is to make surgeons more caring or less capable of making hard, rational, dispassionate choices. There is value in having a person whose hands hold my life in the balance being a person capable of insight and compassion. Think of Richard Selzer, Sherwin Nuland, Pauline Chen, Atul Gawande, and Loyal Davis...all renowned surgeons, accomplished writers and keen observers of their own motivations and their patients' dilemmas. These people, at least in their writing, did anything BUT suppress their emotions.
Both...very interesting comments! :)
"technically dangerous surgeon. " Scary thought... that someone could have a surgeon like that. God Forbid!
I'd take a competent surgeon over a sensitive one... but if I can have both..then that's just icing on the cake.
If you haven't read this..one of my favorite surgical posts is Dr Schwab's "Taking Trust". I believe he wrote it in October, 2006. A moving post. :)