Medicine from the heart . . . Pamela Adelstein
On Thursdays, the Daily Voice showcases selected Thursday Morning Memos, reflective essays about clinical experiences written by faculty, alumni, residents and students of the Department of Family Medicine & Community Health and, occasionally, contributors from other departments. Thursday Morning Memos is UMass Medical School’s homegrown version of narrative medicine, in which the authors process their experiences through writing. To learn more, visit: http://www.umassmed.edu/news/articles/2011/personal_stories.aspx.
Being present for people's stories
One of the richest, most rewarding parts of my work is that I get to be present for people's stories. My patients share intimate, real details of their lives—the milestones, the challenges, but also the traumas. Working with an inner city population, I see patients who have tragically had more than their fair share of trauma. Thus, the part of my work that feeds my soul also drains it.Last week I worked one of those draining sessions. A woman had recurrent ovarian cancer. I did not know her well, I had not known her at the time of her initial disease and treatment, and I have only seen her a few times. She has great social and medical support, and was not looking to me for extra support. I sat with her, gave her comfort the best I could, and I believe I am thinking of her and our visit much more than she.Then two teenage siblings are waiting for their well checks. Midway through the visit, the mother, who is also my patient, asks me if there is anything wrong with her daughter's neck. When I reassure her, the mother tells me that the girl is bullied by her brother and by schoolmates, and they tease her that her neck is too long. The girl starts to cry, the boy starts to act out, and I think about the mother's depression and difficult relationships that she has shared with me at her own visits. We talk about bullying and self-esteem, topics in the forefront of the media today, as I attempt to help, feeling that any help I offer is woefully inadequate.Next is a patient with an eating disorder and depression, whom I see for acupuncture. She does not have many people in her life whom she trusts, but as her acupuncturist, not her medical doctor, I am a special safe place for her. However, that is now threatened, as her PCP is taking a family leave, and I will be filling in the medical role for a few months. I can see her worry about this in her entire being, as she physically cowers, shakes and shrinks as we discuss how we will negotiate this change. I am walking a fine line, and it pains me, especially because all I want to do is take her home with me, tuck her into a cozy bed, hug and feed her.Feeling tired, I knock on the exam room door where my next patient, a Haitian grandmother awaits. Her daughter tells me she is losing weight and not sleeping. When I inquire, I am told something vague about one of the grandchildren being in trouble. It is clear I am not to pry. But then, I am alone with the daughter in the room—and she looks me squarely in the eye, and says, "Because you are my mother's doctor, I will tell you."Whenever there is a crime in Boston, I wonder, partly tongue-in-cheek, mostly seriously, whether those involved are patients at my health center. Often they are, and I absorb this information. However, the story the daughter told me has haunted me ever since. The grandmother's tale is a story about the granddaughter in trouble with the law. Often the media will report on the impact of a crime on a victim's family, which is quite different than the effect on a perpetrator's family. Hearing the shock, worry, fear and confusion of the daughter was so raw and overwhelming, and I was only feeling a small fraction of what their family is experiencing. I offered a nonjudgmental sympathetic ear, a few minutes of unhurried, unpressured time and some hugs. The daughter was profoundly grateful, and told me that sometimes the act of listening is the greatest gift. It was one of the most important things I did that day.But, as I return to my suburban home where everyone is thankfully safe, I am a vessel filled up with other people's emotions and experiences, as well as my own. I am also a mother, a daughter, a granddaughter and empathize with all of these stories from the vantage point of my different roles. Vicarious trauma—not having had the first-hand experience, but feeling the emotions as if one had been there—is a reality in all of our work as physicians. I think about this concept almost every day. We all have experienced it, and will likely again. What do we do with this? As someone wiser than I has said, self-care is critical. But taking good care of ourselves is also a challenge in our busy, demanding lives. For now, I breathe, sit with my emotions, summon gratitude, do the best that I can and bear witness.