the Good, the Bad ... Continued

menopause, she wanted to check in and talk about controlling symptoms. Instead, her urine pregnancy test was positive. I sat with her as she sobbed uncontrollably, unable to contain her joy. I was by her side while she video called her husband, who cried even harder. We laughed together and danced around the room for far longer than the 15-minute appointment allowed. These moments changed my story.

I was called to consult on a patient whose mental status overnight had changed; he had reportedly been unresponsive to sternal rub. He had since perked up, but the primary team wanted neurology to evaluate whether he had had a stroke or seizure. I entered the room and asked the patient whether he remembered people trying to wake him up overnight. “Yes,” he told me, rolling his eyes. He went on to share that he found it “very annoying” that people are always “poking and prodding” in the hospital and that his care team “talked too darn much,” so he had decided to “play dead to punish them.” Just a month prior, I had lost my grandfather, a less dramatic but similarly no-nonsense Kansas farmer; this patient reminded me so much of him that I laughed until I cried. I ended up sitting with him for an additional 30 minutes as we swapped stories about our loved ones. These moments changed my story.

Pre-rounds, rounds, orders, consults, afternoon rounds, around and around. It is easy to get lost in the tasks and the routine and forget to pause for the moments of humanity. As I look ahead to my next steps, I am most looking forward to countless more moments that will change my story. The patients who will make me cry or smile or laugh until my belly hurts. The attendings who will remember a patient’s birthday and go out of their way to celebrate it and the nurses who remember family members’ names and the peers who will make me feel like I am not alone. This job is good and it’s bad and it’s weird, and my only hope is that we allow ourselves to be flexible, to be unsure of what sort of doctor we want to be and to instead allow the strange, wonderful humanity that is the medical field to shape us and never let it stop shaping us. +

Megan Hansen, MD is a graduate of UMass Chan Medical School. She will be pursuing Internal Medicine residency at Duke University.

Writing: An Outlet and a Vessel

Rebecca Kowaloff, DO

In healthcare we are witnesses to and protagonists in the key elements of drama. Every day we face sorrow, pain, elation, love, anger, and suffering, through and with our patients. Stories unfold with unexpected twists and the constant character in all of it is the sometimes-fickle human physiology. Often, we are the visionaries, fairly certain we know the story, and we must bear the burden of an exclusive knowledge which feels like foresight, unable to author a different ending. We carry the unbelievably precious weight of human lives and wellbeing in our hands, and though we have specialized knowledge and honed skills, we are, after all, only fellow human beings tasked with a superhuman mission. How do we bear this burden, when so many of those with whom we are closest do not understand, and when medicine demands perfection and precision and worships the deity of cure? For some, an outlet lies in narrating these dramas, and in examining our role as a participant in them and our feelings tied to them.

There is a growing wealth of literature on teaching narrative medicine skills and its benefits for healthcare professionals. Writing helps many in healthcare process the daily tragedies and our self-doubts in the face of such an awesome responsibility and allows us to acknowledge our emotional investment and “to midwife the life scrutiny that inevitably accompanies illness” (1). Writing about patient encounters provides an opportunity to sit with an experience, to examine it with a metaphysical lens, and to reflect on the “transcendent truths, exposed in the course of illness, about ordinary human life” (2). I have found that as I have written more about patient encounters, I have begun to notice more of the concrete personal aspects of the experiences, such as items of clothing and mentions of hobbies or careers, that suggest more about the person and inform their experience of illness. This has helped ground me in the moment, reminding me to capture its entirety, surely making me a more attentive and thoughtful doctor. Writing can be both an off-ramp for sadness and feelings of powerlessness, and an on-ramp to a level of emotional engagement with our work that is not encouraged in our training or by the structure of modern healthcare delivery.

Combating burnout is a popular topic in post-pandemic healthcare discussions. Writing and engagement with the arts as a way to comprehend our work and rediscover our purpose can serve as a powerful tool in this mission. The act of switching from left brain to right brain thinking in and of itself can help sustain us through the stresses of a medical career, giving us a break from focusing on minute changes in lab values and piecing symptoms into diagnoses, to appreciating human physiology and the privilege of being entrusted with another’s health and sometimes their deepest fears and secrets. As physician-writer Anton Chekhov wrote about his two “mistresses,” medicine and literature: “when I get tired of one, I spend the night with the other … neither