For my previous two posts in the Legilimency series, I approached the subject of doctor-patient interactions from a magical point of view; the doctor/medical student casts the Legilimens spell (a well-conducted interview) on the patient, and the doctor gains insight into the personal circumstances that surround the patient’s health. If you are familiar with the Harry Potter universe, however, you may know that magical spells can often rebound onto their caster. Even Harry, who had no experience in Legilimency, inadvertently caused the Legilimens spell to backfire on Professor Snape, so that Snape found his own mind being read and influenced by Harry. In the medical field, Legilimency rebounds onto physicians almost every day; I will share just two of my recent experiences below.
This post was initially planned as Part 2.5, but a new event from the past week prompted me to write a complete Part 3. I do caution my readers, however, that this post is a bit more emotionally involved than Parts 1 and 2 of this series. Nonetheless, I believe that such events are a critical component of the student doctor experience.
Names have been altered to protect the privacy of all those involved.
Part 3.1: Last Thursday
We arrived in our small group classroom for another day of Systems Navigation. We would be having our third and last standardized patient for the preparatory unit of this class – a trained actor playing the part of Todd, a middle-aged man recently diagnosed with terminal cancer. I watched three other students take turns in interviewing the patient.
With an impossibly weary, broken voice, Todd related his life story to us: his bittersweet childhood with a disability, his decades-long marriage that was just now dissolving before his eyes, and the many accomplishments of his children that he took pride in. He greatest fear was that he would not live to see his daughter graduate.
As our interview time slot came to a close, Lily, the last student interviewer, asked Todd:
“If there was one thing that we could do for you – what would it be?”
Todd averted Lily’s gaze, opened his eyes wide, and lifted his eyebrows to the ceiling, prompting a sea of wrinkles to appear on his forehead. At that moment, he looked older than anyone I had ever met. His parched, upturned lips clamped tightly together, suppressing the quiver that threatened to escape from within. He sighed deeply through his nose, as if the extra air flowing through his eyes and nostrils could dilute his grief; dry out his tears; or perhaps combust the source of his grief, burning it out of existence. But no matter what we said, as outsiders, we could not take his pain away; we were left to listen, and to wait, with bated breath.
As we watched, Todd’s face turned a deep shade of red. When he looked toward us again, his dark eyes shimmered with tears.
“Tell – “
Lily held her breath.
Then, with the softest plea trickling from his lips:
“Tell me that it’s all going to go away.”
Without warning, Lily lost it. As our professor whispered “time out,” her eyes were streaming uncontrollably. The spell of the mock patient-interview was lifted; and yet, when she tried to laugh, the contractions of her diaphragm emerged only as a tortured cry.
Todd offered Lily a warm hug before leaving the room. I caught a glimpse of the actor setting off briskly down the hallway; he had recovered so readily, while I surely had not. I spent the rest of the afternoon and evening in a stupor. A harrowing day in history had become a crucial day of my life.
Part 3.2: Friday, August 8th, 2014
Since our White Coat Ceremony, a number of real patients have visited our first-year class to speak to us about diseases we have been studying, including myasthenia gravis, type 1 and type 2 diabetes, osteogenesis imperfecta, and phenylketonuria.
Undoubtedly, I’ve learned the most about life from the patient with cystic fibrosis.
I first heard about cystic fibrosis in my second year of undergrad. It was briefly described as a genetic disease that destroys the thin fluids hydrating the internal organs, replacing them with thick, sticky mucus that overwhelms the lungs and pancreatic ducts. Patients often die of chronic lung infection and respiratory failure; there is no cure. I never once considered that cystic fibrosis might be a survivable disease.
And yet it was; and I will never again underestimate the indomitable will of human beings to survive.
This brave young man narrated the remarkable story of his life – of managing chronic respiratory illness throughout his childhood and teens, emerging from the brink of death after receiving a double-lung transplant, and experiencing the joys of raising a family. He inspired me even more because of the silent tears in his eyes. He had survived so much pain in his life – even more emotional pain than the physical pain of scarred lungs – and yet, he was positive enough to laugh through his tears that cystic fibrosis wasn’t “all bad.” He could indulge in all of his favorite greasy foods while his family and friends followed stringent diets, because he would never gain weight.
When our professor invited us to thank the man for his visit, I did not believe that a simple round of applause would do him justice. For a terrifying ten seconds, I was the only one standing in a sea of people. Then, slowly, my neighbors joined me; and like a gentle breeze rippling through a meadow, the rows of medical students rose in a standing ovation that swept my breath away.
I will remember the man with cystic fibrosis as the one who reminded me that healing is possible after a tragedy or severe illness. Additionally, he showed me that tears are an acceptable, even welcome, ingredient of healing. With tears, we can embrace the emotions that make us human; with tears, we can stare down obstacles and summon the right memories to overcome them.
As my three-part series on Medical Legilimency draws to a close, I would like to make an effort to learn how to speak with people who are experiencing grief or loss. Many doctors specialize into fields that do not involve divulging terminal diagnoses; however, all of us will have to comfort a friend or family member during challenging times. As a student doctor, I now feel a moral obligation to learn how to lead that discussion in a way that promotes emotional healing.
Based on this realization, I recently signed up for a real-life Patient Navigation commitment as a part of my healthcare systems course. Starting in November, I will be working one-on-one with patients at a Harrisburg clinic to understand where they come from, and help them access appropriate healthcare resources. There will be a steep learning curve on my end, I am sure, but I am eager to begin the process just the same. As much as there is to learn from the doctors who came before me, there are entire new dimensions of healing to be learned from my patients.
Finally, to my readers: thank you for following me through a challenging collection of experiences. I would have abandoned this series long ago without your support.