What We Stay Alive For
Image source: Unsplash
by John Kim
“…And the human race is filled with passion. And medicine, law, business, engineering, these are noble pursuits and necessary to sustain life. But poetry, beauty, romance, love, these are what we stay alive for.”
-Dead Poet’s Society
Reading is one way in which I occasionally allow myself to be distracted. One day last Fall, I had chosen to read The Good Doctor, a short story assigned to us in preparation for a discussion on the value of narrative within our medical curriculum. I was a few hours into a rather frustrating study session on histology and the story of Mrs. Buckholdt, a 44-year-old woman with a psychiatric disorder, and her visiting physician was just what I needed to forget the miasma of purple and pink swirls, spots, and streaks that were taking over my mind. Two pages in, I could almost smell the “stale candy and the chemical salts of cheese-flavored snacks”1 as I, alongside Mrs. Buckholdt’s visiting psychiatrist, entered her house. We called out to her together, as if greeting a patient whose room we had just entered. Both of us had traveled a long way to see her; him from a driving distance of two and a half hours, and I from my own world on the other side of the page. However, unlike the psychiatrist who had gone through years of training to think like a doctor, I had just begun my medical education and was less inclined to do so.
The next week, I shared with my peers in my discussion group about the trip that I took to Mrs. Buckholdt’s place. I told them how her gaze had lingered on a print of a painting hanging behind us (Brueghel, I think) and how I had wished that the psychiatrist had taken up the subtle invitation to converse about it. I lamented how it was a lost opportunity to connect with Mrs. Buckholdt and wondered whether it was at that moment that she had decided to no longer be our patient. The definition of a “good doctor”, something which I had been pondering about long before the start of my first year, proved elusive still. I had hoped that the number of hours invested into my studies would, by bestowing me more knowledge to act upon, allow me to draw me closer to that definition. However, any reference or usage of medical knowledge seemed to hinder more than help in the situation that I had found myself in. Oddly enough, the “good doctor” that I envisioned turned out to be someone who could think, appear, and feel less like a physician.
As I wrestled to resolve this paradox, I was reminded of many small moments during my first year that had been memorable, simply because of how they had allowed me to forget that I was studying medicine. I found myself conversing with a stranger at a climbing gym about EDM festivals that took place in forests, tearing up after having finished a tragic TV show about love in a futuristic city, and watching proudly as my sister got married to an old friend of mine. It was moments like these, or the feelings that they came with, which taught me something that my medical curriculum had not; the joy that comes with living.
Last year, I had the chance to read Being Mortal by Dr. Atul Gawande (2015), a practicing surgeon who has authored other well-acclaimed books on healthcare such as The Checklist Manifesto. In his book, Dr. Gawande presents to us the stories of his patients, including his own father, to introduce a compelling question about what it means to really live. Medicine has traditionally been concerned with preserving and extending life, which has allowed us to live longer and become more resilient to sickness. While this is a notable achievement, Dr. Gawande argues that life is pursued based on the reasons we wish to live it for, not necessarily the length to which we can extend it. Medicine, with all its miraculous ways of governing biological processes, can enable us to pursue well-being on our own terms.2 When given the opportunity to live, we wish to do so with autonomy, fulfillment, companionship, and a lasting degree of childlike curiosity as we are left to freely interact with the world around us. To live is to be both present in our moments and present with whomever may be with us during those moments. It is a deliberate effort to regain control of our autopiloting selves and allow ourselves the luxury of connection, whether it be human, natural, or spiritual. There is no better way to see a person than to see how they seek out these connections, and how they are weaved into a magnificent amalgamation of comedy and tragedy that represent who they are. This perspective is what is emphasized in the medical humanities curriculum; to emphasize the role of our various identities, experiences, and the connections made between them as tools for cultivating empathy and patient-centered care, ensuring that future physicians do not lose sight of the people behind the illnesses they treat.
Reading stories such as The Good Doctor helps me to regain control, albeit for a brief moment. As a medical student, there is always more to study and never enough time to do so, so I find myself constantly chasing after that elusive feeling of accomplishment, hidden at the end of several lectures and hundreds of Anki cards. It doesn’t occur to me that somedays, it is enough to simply be a son, a brother, a neighbor, and a friend, until I find myself in Mrs. Buckholdt’s living room next to a psychiatrist who can’t see past his desire to write her a prescription. Unlike the syntax and jargon used by this psychiatrist to assert his own control and authority, the language used by the authors of such stories is familiar, relatable, and reminiscent of my days before the chaotic demands of medical school, a time when it felt more natural to be humane and caring. The past two decades have shown growing support among medical educators for the value and necessity of humanities training in medical education, which approves the use of such familiar language.3 These include the “old words” described by Dr. Kumagai*, an endocrinologist and a long-time health humanities scholar, as those of which we have heard before but may have forgotten their relevance to ourselves, words such as “wonder” and “mystery”. As a champion for the health humanities, Dr. Kumagai has advocated for the need to teach medical students how to supplement their vocabulary with words that can expand their spectrum of human expression and understanding.4 The trajectory of my medical education emphasizes the importance of basic sciences where these “old words” tend to get buried under more objective language describing data and processes. I find myself struggling to apologize, to empathize, and to encourage, all of which rely on my mastery of the “old words”. Without them, my conversations turn into stale formulas and I may, not unlike Mrs. Buckholdt’s psychiatrist, also find myself being overtaken by the numbness that comes with chronic overexposure to pain.
Most of us can probably remember a time when neither school nor spirit kept us from giving ourselves over to the various distractions of life. I remember sleepovers with b-horror movies, 2-hour long waits for amusement park rides, and beach picnics that served sand-laced sandwiches. Once while I was still working on medical school applications, I heard that some of my favorite local House music DJs were invited to play at an event in my city. I drove there alone on the day of the event, dressed casually and carrying nothing else but a heart full of anticipation. I danced for hours that night in a dark bar with a low ceiling amongst strangers and heard nothing else but the constant stream of music coming from the speakers. Distractions such as these transport me out of the molecular level of thinking and place me amidst the human experience of what it means to live, to love, to become sick, and to become well. It speaks to me the importance of “[the] awareness of bearing witness to and participating meaningfully in those events that make us human”4 which is ultimately what is highlighted in our medical humanities curriculum. As aspiring clinicians who will help sustain and improve the lives of others, it is important that we connect with the experiences of our patients that enrich and elevate their lives. It is also equally important that we find ways to enrich ours as well. The reasons for which we stay alive, as opposed to the act of survival itself, may be crucial in defining our personal and professional success as student-physicians. Thankfully, those reasons may not be too far from us, perhaps waiting to be uncovered in the next distraction that comes across our way.
1. Gawande A. Being Mortal: Medicine and What Matters in the End. London: Picador Publishing; 2015. 304 p.
2. Kumagai AK. Beyond “Dr. Feel-Good”: A Role for the Humanities in Medical Education. Academic Medicine. 2017 Dec; 92(12):1659-1660.
John Kim is a second-year medical student at NEOMED
