by Mandy Esquivel (Class 2019)
I read it in a book once. I just didn’t believe it. But once I read that one day in your medical training, you would have an epiphany moment, where you would realize that you had gone from watching medical dramas to becoming the lead actors in them.
And today, it finally happened. I had my moment. It was nothing like I thought it would be.
Someone called a code, and everyone in the ER stared as a team of medical professionals rushed over to the patient to start chest compressions, to intubate, to slip catheters into arteries, to push intravenous drugs into his body to keep him from dying.
Except — well, it wasn’t as glamorous, or as exciting as in those shiny movies or TV shows where somehow everyone still looks perfect, and you either save the patient or learn some life-altering beautiful lesson.
Here, it’s just.
Somebody someone loves, without a heartbeat and unable to take a breath.
The person who loves them sobbing in the corner, politely pushed out of the way, but still slapping at her husband’s feet, begging him to wake up.
An exhausted and swamped resident barking out orders.
And three tired medical students — one of them me — rushing to comply. I insert the cannula, run the IV and watch the nurse give epinephrine while another intubates and the other begins compressions. With the airway patent and the line running, our resident oversees the entire process while we three take turns doing the compressions, each one wearily looking at the other. Twenty-two minutes later, the reading is still asystole, and I can read our glances at each other over the patient’s body as if we had said our mutual thoughts out loud: how long do we have to do this?
Later, after twenty-eight minutes of chest compressions that proved futile, and assuring the family that we had done everything we could, I sat down to do paperwork for the now-dead man. I sipped a soda while detachedly listening to the family weep and say their goodbyes.
That was when it hit me.
To my horror, my most pressing thought was that the ice in my soda – the only thing I’d had to eat or drink the past ten hours – had melted while we had coded, leaving a stain on the table as well as making the drink distinctly and unappetizingly watery. I was logically sad about the man’s death, but the actual emotion escaped me.
And I wondered when I had let myself become this person.
This early on in my career, I had observed a lot of suffering. Perhaps understandably, but still unforgivably, I was becoming immune to it. Surrounded by sickness and death and those trying to fight both, I discovered that in order to function properly, I had to become somewhat detached. There was no point in me becoming so depressed I couldn’t function. I could not care so much about every patient; it would kill me. It was only healthy… wasn’t it?
Still, I wondered: what kind of person was I now? What kind of person was I to see all of this, to be part of it, and to somehow still feel nothing? In my quest for medical and technical excellence, was my moral compass pointing somewhere far from north? Was my capacity for empathy and compassion lessening? In my quest to learn to save lives, was I forgetting one of the most important things about being a doctor — the humanity that protected that sacred doctor-patient relationship, that drove us to do the best for these patients who, prior to being patients, were people?
There was a time not too long ago when I sat in the callroom and cried over the death of a stillborn baby. When I made time to sit at the bedside of a patient who was old and dying, and let her hold my hand as she told me about her grandkids. When I offered mass or a rosary for the patients whose deaths I had witnessed. When I willed myself to smile at every patient I encountered, even the belligerent ones, never got visibly exasperated at their companions, even when they badgered me as if everything was my fault, took the effort to remember everyone’s first names instead of just the lady with UGIB or bed 43. Patients used to tell me I was the nicest or friendliest, the most willing to explain, the girl least likely to shout.
I remembered it. I wanted to be that girl again.
So I did.
I studied hard. For better patient care, rather than to get high grades. I didn’t always succeed — God, were there failures — but with every failure I learned something, and I used them all to motivate me to work harder. I plastered a smile on my face and added a joyful note to my voice, until it became almost natural. I struggled to stay cheery even when I felt anything but. I reminded myself that these patients were people, and I told myself to treat them how I myself would want to be treated. I pretended each old person was my grandma, each wailing child my kid sister. I made it personal. Such a simple rule, but one that was ultimately fruitful. When the world wasn’t kind (and there were many times when it wasn’t), I struggled to be that much kinder.
It is passion driven by compassion which makes good doctors.
Two weeks later, one of my juniors, who has been shadowing me for a few hours, approaches me, shaking his head. “How do you do it? Everyone seems exhausted, but you’re still bouncing around, smiles and all.”
I smile at him. It’s been sixteen hours since I went on duty, and I think all I’ve had since then is a donut and a cup of coffee, but I have not felt so alive or so human – so humane – in a while. And I told him what it had taken me a few months to figure out: in the midst of suffering, it is part of our duty as physicians not only to treat or palliate, but also to stay calm, to stay kind, to help our patients and their families navigate the unholy world that was illness and death.
A month later, a patient of mine died. And when we stopped the code, and I met her husband’s eyes over her body, I felt the characteristic lump in my throat, the welling of tears in my eyes. She had been fine yesterday. Here one minute, gone the next. She was four years older than me, and they had just gotten married last year. They had a one year old kid. It was personal. It was real. The truth was, if you tried to get to know them, it always was.
And even if I had to go to the bathroom to compose myself before I could continue on with my work the rest of the day, I was grateful. Maybe it was better to hurt. It meant I still cared. I was even more grateful when I received a text from my patient’s husband a week later, thanking me for doing what we could for his wife. It’s probably one of the proudest moments of my med school life to date. That a patient whose wife had just passed still felt that he could say thank you. That he knew I had really cared. “Doc, alam ko naman di natin siya pinabayaan habang buhay po siya. Salamat sa lahat.”
We cannot save everyone. I am beginning to learn that we actually should not. Part of being a doctor is knowing when to treat, when not to treat. When to cut, when not to cut. And when we face illness or death in the eye, I am starting to see that the profession I have chosen is often, if not always, about how gracefully and how well we play a poor hand. Even if we know the deck is stacked against us – because death comes for all our patients, and us, in the end – it is still our duty to play the game as well as we know how. For them. For our patients.
Medicine is a science, yes. It requires competence and excellence. But it also requires compassion. And that’s what makes it an art.
I haven’t mastered either art or science yet — boy, do I have a long way to go — but I hope that because I am aware of the need for both, the time will come when I will be.