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Losing Your Soul
Ali Tabatabaey -- 49 days left…
I've tried to get everything together, and the checklist is almost complete. Lecture notes, previous tests, pretests, a color atlas, a couple of dictionaries, a few major textbooks, some CDs, and last but not least, me! Great, just one question: where do I start?
I stand a couple meters back and look at the pile of books and papers on my desk and think to myself, "wow! I've studied all this in the past 3 years and have earned an acceptable mark?!" -- but that "wow" turns into an "ouch" when I turn that retrospective view into a prospective one: "you mean I'm supposed to master all these again …!"
48 days left…
I've decided to start with the more recent courses, psychiatry, pediatrics, gynecology (I'm still open to suggestions), but for some unknown reason this "recent" material seems awfully unfamiliar. Is it me, or has all of my medical knowledge evaporated? I'm still trying to keep cool. I'm sure things will improve. Maybe not today and maybe not tomorrow, but hopefully some time within the next 7 weeks!
46 days left…
Today I found out that a good friend -- a classmate and a distant relative -- is suffering from what seems to be Grave's thyroiditis. To my surprise, he had gone through all the symptoms, lab tests, diagnosis, and a couple rounds of treatment, and I hadn't even noticed. I can't believe I've been so inattentive about life around me. I didn't even realize that this friend had been missing classes. For someone like me who takes (used to take) pride in being humane and affectionate, this was a sheer disgrace. I used to take interest in the well-being of others, ask how they feel. Yet these days all I care about is school. How did this happen? Why do I want to become a doctor after all? Isn't it caring for others?
Sometimes we forget that the textbooks are about the people right around us. Here was my friend with hyperthyroidism, right out of the textbooks and sitting in the car beside me. I had read about the disease many times, but what he was talking about was completely different. He didn't just talk about irritability, tremor, orbitopathy; he talked about waking up drenched in his own sweat, frustrated about the inability to stop the process. He talked of a compulsive sensation to start a fight about nothing and regretting it a minute later. He described the nerve-wracking experience of having a shaky hand that drives you nuts, and the hopeless attempt of stopping it with the other hand, which itself can't keep still.
I had studied hyperthyroidism. I had seen the patients. But never before had I paid attention to the person suffering from it.
We, the medical students of the 21st century, are so preoccupied with the mechanical diagnosis and gathering of criteria that at best we can hope to be a well functioning computer. While on this course, we will never feel the true sense of satisfaction that doctors used to enjoy generations ago.
I just wish that medical teaching had been more humane. It seems that the first thing they do to us on entering school is to strip us of our soul, and to teach us disrespect for the human body and soul. First semester and you have a human corpse at your disposal. You might hesitate a little at first, thinking: "he was living once, just like me," but soon you learn to forget about such affections that do you no good but to be mocked by others.
And so it happens. Before you realize it, the sweet and caring person who once chose this course to care for human life, turns into a monster that couldn't care less for the human soul; Someone who greets a patient suffering from a mortal disease with a satanic grin, just for the sake of the physical examination.
I'm ashamed of myself. I remember my early days when I promised myself to be different, to care, and to work passionately. I just hope it's not too late to turn back.
January 27, 2006 | Permalink
Comments
It's not too late. When the studying is done, you will learn to incorporate the caring with the education. The majority of the doctors I have worked with have been able to do that.
By the way, you look suspiciously like Anthony, and yet it says you're Ali....or is this a new photo of Ali that looks like Anthony?
Posted by: Kim | Jan 28, 2006 6:54:04 PM
When a photo is taken just after dusk in front of a huge light projector, anyone can look like anyone else!
Posted by: Ali Tabatabaey | Jan 28, 2006 11:47:35 PM
Either way, you're cute.
Don't worry, I'm old and married....LOLOL!
Posted by: Kim | Jan 29, 2006 6:36:36 AM
I have never read these postings before- I always get the medscape emails only to have them sit in my inbox for a week with the intention of reading them.... but then the day comes that I realize I will never have the time so I delete it. Today was different, I am braindead and cramming for the 3rd exam this week- the email was a nice break from reality. I found your entry to explain exactly how I feel daily and it made me smile. Thanks for your words.
Posted by: Tricia | Jan 31, 2006 2:07:59 PM
I know how you feel about your friend....I had a personal situation similar except I was the patient. I started getting headaches, visual problems, and irregular menstration pattern. I thought it was stress of studying for boards and general not taking care of myself. I soon found my little prolactinoma friend. Pathetic when you don't take time to realize you have a health problem in your studying.
Posted by: G | Jan 31, 2006 3:23:07 PM
I think your observations and experiences are definitely the rule, rather than the exception.
I think medical school has become something of a glorified trade school, where we have forgotten about the inherently moral nature of the endeavor.
Medicine thinks that there are good things that ought to be pursued, and only by certain means. We are making moral judgments when we say things like that. That has incredible implications for both the practitioner and the patient in so many ways.
The problem is that our medical education and training says little about pondering such issues, and often tries to steer away from thinking too deeply about such things.
Posted by: Phil | Jan 31, 2006 3:25:29 PM
In response to Kim, I agree that it is not too late. However, I do think that medical school ought to be incorporating more discussion about such things sooner and more intentionally.
Posted by: Phil | Jan 31, 2006 3:27:34 PM
I'm a pre-med student, winding up her undergraduate career at Berkeley. I want to learn medicine, and take the time to learn to care for people as well. Do you think some medical schools emphasize this more than others? If so, any suggestions?
Posted by: Cynthia | Jan 31, 2006 3:52:33 PM
As much as I love blaming the system, I think the burden of maintaining perspective falls on the shoulders of us, the students. These professors and course directors have one job; cram information into our heads in the hope that we remember half of it. They don't really have time for more. Sadly, schools don't work in more ethics/moral lessons for students to discuss and when they do they mostly deal with avoiding trouble and not treating people. We as students need to take the time every now and then to remember why we're here.... It's hard to find time but you have to do it to stay sane and (for me anyway) motivated. Don't let medical school suck the soul out of you. Take the time to find it again even if that means taking a break.
Posted by: Walt | Jan 31, 2006 6:12:02 PM
I just found about your blogs from medscape today. I was fascinated and amazed by the way you express and write. I am trying to switch from being an electrical engineer to a physician (in the middle of the application process).
As I read your blogs, I kept thinking - these are the reasons I want to become a physician. After all the things that are said and done, I think in the end what matters is our relationship with other people.
I think medical schools should emphasize on treating patients as fellow human beings and show kindness. But I honestly think it comes down to individual physician's mindset and perspective. You can teach someone about cultural diversity all you want, but it has to come from within. Medical schools can and should definitely play a role though - to guide the students.
Thanks for writing these blogs.
Durham, NC
Posted by: Shahab | Jan 31, 2006 6:51:08 PM
Medicine has become a business like the other aspects of our society. The individuals that desire to go into medicine find that they are constantly being pulled in every which direction. Medicine now is definitely not what it use to be but there is that small glimer of hope that each doctor will be given the opportunity to show his or her humane side. It's true that we should not forget why we all started this field yet in the end try not to let this issue of human nature keep you up at night.
Posted by: Los Angeles | Jan 31, 2006 7:02:56 PM
I have found my soul in medical school. I agree, as a whole, the institution of medicine is just that, an institution, too often void of humanity. But the individual physicians, the students with that initial passion, the stuffed away and forgotten intuition and the lifelong strength of truly caring for people around you, do exist no matter how drowned they all are by the exams, the disconnection required to cut a cadaver, the eagerness to get that geriatric PE.
I am a Naturopathic Medical student, about to graduate and take my clinical board exams. My days are also full of classes, clinic rotations, studying, lists of things that need to be done, time that has to be managed, and a head too full of information I never knew I was lacking in before. But, I also have had the experience of cultivating myself, my view of the world and my view on humanity over the past four years. Cadaver lab began with a moment of silence to honor those who had passed on and given their bodies to us for our learning. We have taken courses in cultivating ourselves, and I have found it essential and been highly encouraged by supervising physicians to do whatever it takes to truly find myself in this process, to cultivate my soul.
A physician told me the other day that I already know everything I need to know to be a physician; that now is the time to really focus on who I am, and the physician I am going to be. What an amazing affirmation.
Now, truly, my life will be spent gaining knowledge. Doctoring and learning are inseparable and I wouldn't have it any other way. What I know now is only a fraction of the knowledge I will have five, ten years down the road after seeing hundreds of patients. But, I also know that much of the knowledge I will gain in those ten years will be a continuation of this connection to humanity - of really learning what makes people ill, what makes them healthy, what gives them life, happiness, sadness, depression, disease and cure. Rarely is the true cure the medicine, the knowledge or even the doctor but the journey the patient is willing to embark on. And for ourselves, we must also be ready and willing to grapple with that journey, keep learning about ourselves, keep practicing our intuition and always remember to care, to take the time for a friend, for a patient, for ourselves and put the "information" we all have stuffed into our brains on the back burner for the sake of humanity. It will come into play whenever it is necessary.
I am so thankful for my medical school experience and very ready and equipped to now help my patients follow their path to wellness.
Thank you Ali for your honesty in this issue and for struggling with your own humanity. You will be a great doctor because of the questions you ask, the observations you make and the desire to be a truly caring person.
Posted by: Amy | Jan 31, 2006 8:00:23 PM
Naturopathy? What a waste. Ali, you're a sissy.
Posted by: M | Jan 31, 2006 9:16:06 PM
Unfortunately, this is the nature of the current medical school beast. In preparing to apply for med school, it seemed that the more I learned, the more disillusioned I became. Ultimately, I decided to go the Nurse Practitioner route. I am so glad I did. Overall quality of care is the same, but patient satisfaction is much higher with NP's.
At least you recognize the problem. I agree with most others, it's not too late. Stay grounded and remember the reasons you went into medicine.
Posted by: Sabrina | Jan 31, 2006 10:38:21 PM
You know I've felt this way for a while, and have also told many people the exact same thing. I know there is no way I can go back to being the person I was before medical school. For better or worse I'm a different person.
Posted by: J | Feb 1, 2006 8:52:24 AM
The Medical Feild is surely part of the "Dajjal System"
but you can still use it for the goodness left in it!
Posted by: Taalibah | Feb 1, 2006 9:49:02 AM
I have been asking myself same questions in this few last months: "How did this happen? Why do I want to become a doctor after all? Isn't it caring for others?"
I am on fourth year in Sarajevo - Bosnia and Herzegovina.
:) we will find the way to keep our humane intentions, I am sure we will...
Posted by: igor | Feb 1, 2006 11:52:28 AM
Bureaucracy is a double-edged sword. In modern times people treat it like a dirty word. The coldness of academia and medicine are the result of the industrialization of both. On the other hand you must consider that bureaucracy was a technological advance in ancient times that allowed mankind to settle into civilization, and again changed the face of the world with the industrial revolution. The ability to create products or perform tasks on a large scale depends on regularity of action, which is the nature of bureaucracy.
This mass production is at the same time a wonderful gift, and a terrible burden. If the office is well run, and every member of the staff does their part the Doctor can treat a new patient every 15 minutes: truly a miracle of modern medicine. More people can be healed in less time than ever before.
By the same token, the patient has been suffering; their quality of life is so impaired they took time from life’s obligations to see the Doctor. Yet they will be treated as a puzzle to be solved in 15 minutes or less. The Doctor will most likely diagnose one of the top 50 common complaints, because statistically that probably what it is. If the patient has the bad luck to continue being unwell, they will have to return or see a specialist. Surely this cold touch to each other is a shame to all of medicine. People are isolated and unheard, perhaps dangerously so.
The resolution of the dichotomy comes in balance. We need bureaucracy to create efficient and safe places of practice. The system was created to mainstream the majority. To work well with the average patient (or student). Trouble happens when people look to bureaucracy as an authority, when it is really just a tool. Individuals have the ability to go above and beyond to keep humanity in the loop.
In our lives I’m sure we have all experienced, “I’m sorry, that’s not my department…” “Why don’t you come back another time, I’m on break.” “Better luck next time.” A number of factors go into this attitude, but a large contributor is lack of empathy. The other person cannot or will not put themselves in your shoes.
There is a lot of this in medicine. The root fear seems to be: if you empathize you are “feeling” not “thinking”. Furthermore if things get worse for your patient it will be too hard on you and you may get burnt out. I know I recognize it in my Father’s generation prevalent attitude. For his part of the Baby Boomer Generation who grew up in rural America, people didn’t talk about their emotions. Many people’s philosophy was to just work harder to work through it. Very productive, but not any less prone to burnout than people who did indulge in empathy. Here is the interesting part, a lot of people like my Father are still in positions teaching medicine, sharing this philosophy along with their wisdom on medicine.
It is my prediction that in the next 15 years there will be a shift in the attitude towards empathy and soul in medicine. The bureaucracy will still be in place, but the individual will have more personal accountability to go above and beyond in patient care. Not just because a younger generation will be in more senior positions, but because it will also make good business sense.
Posted by: Jade | Feb 1, 2006 5:07:32 PM
sometimes i wonder why they teach us sth that they ,during their practice, choose to ignore. they taught us the main rule was to do no harm. but to see some of them to have a disregard for the patient, to be rude to them n to their relatives, to not give them enough information abt thier disease is unacceptable.. i keep on praying that 10-20 years down the road i'll always remmber that they are ppl n not mere diseases, that'll i'll never be immune to human emotions.
i think sometimes teh environment can turn us into these monsters e.g crazy working hours n a looooot of patients n being understaffed.. in the ned i blame the system for not making the working hours for docs here more humane... but of coz.. i think its multifactorial, the system is just one of the culprits
Posted by: nurul | Feb 1, 2006 8:53:44 PM
I believe the things you say have some truth to them, but as some others have mentioned, I think that not losing your soul is the student's responsibility. To some extent "losing your soul" is adaptive in medicine. If one cannot objectify the patient even a little, then practicing medicine becomes difficult. I do believe that a person should be respected and not just treated for their illness, but as a whole person, however, I do think that undermining some of your emotions at times is necessary in this field.
Posted by: M | Feb 2, 2006 9:19:49 AM
I get how you feel. I was feeling the same way for few months time. It is a common thing happening to most of the medical students but only very few understand that some thing is going on like that. But they are the ones who will work on it and correct their lives and attitudes and their thinkings for the benefit of the patients, cos they know that they should do so. You are one of the lucky ones to understand the real situation. U ll do fine.
Posted by: sscg | Feb 2, 2006 9:52:48 AM
As long as were human well be treating humans, not the diseases. There's a HUGE emphasis on this in Osteopathic medical school. If you have an understanding of how the body has an inherent ability to heal itself, you will realize that you're just restoring health to your friend, and you both will grow from the experience
Posted by: Justin | Feb 2, 2006 10:20:15 AM
Mmm... Seems like some of us, med students around the world, have been asking to ourselves similar questions, about how to stay human in our career... I agree with many of you. And if more people would join us, we could even talk about a real change, real human medicine!!!...Jejeje! Maybe it sounds funny, but I'd love to enter one day to a hospital and see that everyone understands everyone, and everyone truly cares about everyone else... Utopic world? Perhaps... or maybe some dream that could come true... :D Bye!
Posted by: Joy | Feb 2, 2006 10:43:51 PM
I see what you mean.. well, though I'm still in my first year. less doctor cares about patients feelings than it was years ago. we are thought to see patients only as an objects, it makes us forget that they are humans too.
but improvements made. I start studying empathy in the first year now. completed with patients interview session, to help us know how it really feels to interact with patients, to know how they feel. well... there's nothing else we can do than asking their feelings anyway... I'm still in my 1st year, haven't know anything bout their illness, they know it better than I do. it's a great program anyway, gives me an insight of how it is being an empathetic doctor, and how to be one.
how about other (I'm in indonesia)? do you learn empathy?
Posted by: wdy | Feb 3, 2006 6:07:37 AM
"The spirit gone man is garbage. That was Snowden's secret." Joseph Heller (Catch 22)
I warn you, my friends, at the end of the day you do not answer to your classmates, your attendings, or even your family. You answer to yourself...no matter what obstacles school throws at you, you must treasure your identity, your essence. I have been through basic sciences, through the political game of "clinics", and even through the superficial interview process. Do not lose yourselves to the system. You can call this hokie, idealistic-but screw it; that is what I am.
Anonymous 4th year medical student.(the e-mail address works)
Posted by: Bob | Feb 3, 2006 8:53:32 PM
