I am a resident physician, a brand-new doctor. I am just beginning my residency training. The process of becoming a doctor is long and tedious and involves a tremendous amount of work and dogged commitment. We complete undergraduate education, four years of medical school, and three to five years of residency. The hardest part, though, is not academics or occupational stamina — but rather developing a personal and professional identity as you bear witness to the suffering of your fellow man.
We as people collect experiences through our lives that shape us and our narrative. A number of these stories are joyous. Some are mundane and only significant to the individual. And unfortunately, many are sad, even tragic. By the time people are in their sixth, seventh or eighth decade on this earth, they have amassed so many experiences. These experiences offer them a certain perspective — call it wisdom or maturity — that allows them to contextualize novel and stressful events in a way that young people simply cannot. They say things like: “After all my years, nothing surprises me,” or “I suppose that’s just the way life goes,” or “Time is fleeting; you have to make the most of it.” These statements reflect an advanced worldview, one that young adults cannot fully comprehend.
As a medical trainee, you are abruptly exposed to tremendous amounts of human suffering as a fairly young adult. I started medical school at the age of 23. I am now 27. Our systems are flooded with so many human narratives, and we collect “experiences” at a much faster rate than the average person. While some of these stories are hopeful, most are underlined by sadness and loss. And yet, I do not have the benefit of 60-some years of character formation. I have not been able to conduct a great retrospective review of the experiences I have gathered in order to better understand the existential arc of my life, as someone in their 70s can. I see adversity right here, right now. I see sickness and the end of lengthy lives, as someone in their 20s, and I simply don’t know what to do with this.
Immediately, I ask: Should I mourn with my patient and their family? Should I get back to work right away? Don’t cry, or maybe just a little? Why am I thinking so much about myself when the people before me are grieving? Longitudinally, I ask: Where, in my personal narrative, do I place the large quantity of suffering to which I am exposed? Does it become an indelible part of who I am? Do these stories become anecdotes about unnamed people that I share when I meet people, in the same way that lawyers discuss their clients or teachers their students? Or do I tuck these experiences away into a less accessible part of myself, far from conscious reach? This is the challenging process of identity formation that we must undergo as young physicians.
We are taught to establish empathetic relationships with our patients but also to create professional boundaries to remove ourselves from the labyrinth that is human grief. There are no specific rules for how to relate to patients’ tragedies. Every doctor does it differently. I have seen some physicians tear up when discussing poor prognoses with their patients. I see some maintain chilly detachment. Many straddle the line between compassion and emotional distance well.
Doctors must devote a large degree of personal and psychological work to their relationship with human suffering. This relationship is not established overnight; it is constantly changing, and it is never perfected.
So here I am, as a physician in her 20s. I have my credentials. I submit my intellect and my knowledge of human pathophysiology. I am armed with the flimsy skills of empathy and compassion. But I have little to offer, in the way of fundamental wisdom or maturity, to suffering patients who are 40 years my senior.
And yet, patients grant me their deepest certitude. They trust me to treat them, to heal their hurting bodies. Their storied bodies. Bodies holding decades of experiences, that have spent the better part of a century as inhabitants of this physical world. Bodies that have served them well for many years, now before me — someone who knows so little about the scope of her own life. These patients, these people, they allow me to treat them, and in so doing, to incorporate their stories into my personhood. And when I speak, they listen, and they call me “Doctor.”
