“Mr. L is an 82-year-old scheduled for total mesorectal excision of stage IV
colorectal cancer.” As a third year medical student presenting a patient to my new surgical team, my mind races in anticipation of the surgeon’s questions. Fragments of knowledge flash into focus regarding this patient’s case: Wnt signaling pathways, adenomatous polyps, deactivating mutations of TGF- Î². While presenting his case, my mind recalls Mr. L’s responses to questions and I cannot help but try to place his dignified, unpretentious accent. The distance in his eyes occurs to me only after I had left room 482. I was with Mr. L for several minutes this morning and could answer any question my attending might ask regarding his last twenty-four hours. I was embarrassed to admit to myself, however, that I had learned nothing about him. With a consciousness littered by medical jargon, my parents’ words of wisdom infiltrate and sting with awakening: “have compassion, fight indifference.”
“How is the pre-operative CEA concentration predictive of relative risk of death in patients with colorectal carcinoma?” The surgeon’s question interrupts my sympathetic diversion, tempting me to once again equate Mr. L to statistical evidence and lab values.
“The CEA concentration is predictive ofâ€¦” My mouth regurgitates a protracted, effectual answer while I secretly marvel at my ability to reduce this patient to a recitation of evidenced based medicine. As a medical student, I am engineered to obtain a history, create a differential diagnosis, and apply scientific logic to sculpt a reasonable plan. There is no letter in our SOAP note template for compassion. It is easy to allow a barrier to arise, to allow cold indifference to separate the cerebral physician from the compassionate healer he or she once strove to be.
“Fantastic answer. You just earned yourself primary assistant in Mr. L’s
resection.” Just as the surgeon commends my knowledge, I am busy swearing to myself that tomorrow I will make an effort to know Mr. L. Each memory he shares and each facet of his personality I observe will be currency to redeem my self-diagnosed disinterest in him. Little did I know that what I would soon learn from Mr. L would change me forever.
At 6:00 the next morning, I entered room 482 and found a somnolent Mr. L. The room’s oversized window framed the pink light of dawn spreading behind a dark bank of clouds, the rays fighting to touch the fresh January snow. “Good morning Mr. L, I am with the surgery team. Are you having any pain?” My greeting sounded too standard, so I mindfully selected words with more inviting undertones. “This must be so difficult for you. I am here because I want to help you in any way thatâ€¦”
“Bricks!” Mr. L interrupted my greeting. “Bricks!”
“I’m sorry, I don’t underst-”
“I made bricks for them! I have no pain because I have known real pain.” His abstracted accent placed me in another time. Never have I seen such urgency, such intellect as I saw in Mr. L’s despairing eyes. “I was 14 years old when they came to my Warszawa. When they marked us and took us.” Mr. L pulled up the sleeve of his hospital gown, revealing a handwritten brand: 73618. Now fully alert and escaping his hypnopompic confusion, Mr. L assumed a more refined character. He then seemed to position himself in a formal posture more suitable for a visitor. “I apologize,” he said, “I suffer with a dark past.”
“If you would be so kind to share with me-”
Immediately Mr. L began recounting his childhood in Poland, his time in
Auschwitz, and losing his entire family to unspeakable deaths. He spoke of his last 65 years attempting to reconcile the abyss of his memories with his desire to weigh the goodness in each human life. Effortlessly producing a wise smile, Mr. L took my hand and said, “If I learned anything making bricks in those camps, it was that hope is the most vital thing of all. There we were, prisoners making bricks. Strangers turned into each other’s necessity. We ignited each other’s fight for survival. Disease is no different. Become a doctor that understands struggle.”
Tears speckled the clipboard of papers in my lap. I was left without words. My usual template of questioning, the carefully formulated differential diagnosis, the treatment algorithms; I could say nothing. Each of these crutches I had leaned on for so long had vanished. Beaten away by bricks. Mr. L saw my white coat as a symbol of safety to reveal his delicate past. Stunned with reverence, I considered the implications of Mr. L’s bricks. Out of such a detestable scene, he turned the very product of his revulsion into a mechanism of hope. Bricks line the walls of room 482, a place where white coats create an atmosphere of honest transaction. Without care our white coats, the talisman for our compassion, can become another kind of brick wall. They can be a divisive barrier that turns a well-intentioned medical student into an indifferent medical encyclopedia.
“Keep this old man’s words in your heart.”
Of all the things I wanted to say, I simply replied, “I will never forget you.”
Mr. L’s unique lessons serve as formative and enduring contributions to my education. From him I learned that every patient has a story to tell and a lesson to teach. Through his story I grasp the depth and breadth of my parents’ wise words. Medicine provides the daily opportunity to offer compassion and I must transform my medical knowledge into devotion and sensitivity. The simplest form of compassion is also its most significant substantiation: listening to patients in a way that fosters their speaking and speaking to patients in a way that fosters their listening.
This essay by William J. ‘Cris’ Crisler took first Place in the Arnold P. Gold Foundation’s 2010 Humanism in Medicine Essay Contest. He submitted this essay as a third-year student at Creighton University School of Medicine, Omaha, Neb.
The Humanism in Medicine Essay Contest encourages medical students to reflect on their experiences through writing. Since the contest’s inception in 1999, the Golf Foundation has received more than 2,000 essays from more than 130 schools of medicine throughout the world.
Students were asked to draw on their personal experiences and observations to “describe a barrier a physician might face to practicing humanistic patient care, explain how this might be overcome and what can be learned in the process.”
A distinguished panel of judges reviewed the essays, and winning essays and honorable mentions were posted on the Gold Foundation’s website, humanism-in-medicine.org. Additionally, for the ninth consecutive year, the journal of the Association of American Medical Colleges, Academic Medicine, is publishing the winning essays in its three fall 2010 issues.