Understanding Compassion
By Robert Young, D.O., Class of 2020
Dublin
As a medical student, there have been a few times I have found myself in clinical experiences that amount to just shadowing an attending or resident. At the beginning of my training this used to frustrate me; I was eager to practice and develop my skills as a clinician. As time went on, I matured and realized that both residents and attendings alike were also practicing their clinical skills and that often my duty in caring for the patient was elsewhere. My priority as a medical student is to learn whatever I can, as often as I can. I pay far too much to “just shadow”! As I grew as a student, I found myself focusing on the interactions and emotions that went on in patient rooms. One doctor could start a conversation as a means to deliver news and education, and another could walk in a room without a thought for the PERSON in front of them, but only the patient. Two nurses could do the same exact thing required for a patient, but one action performed out of love for humanity of the person and the other action carried out as a cold means to an end for the patient. I have found myself in a truly excellent position as a medical student, to bear witness to these encounters, and learn how to treat those around me with dignity and respect. I have been able to think about the downstream effects of one bad interaction with the medical system: a patient or family may never trust medicine again when things are not done out of compassion and not talking thirty extra seconds to explain something could lead to confusion and fear over a patients situation that makes them return again and again.
During my time as a medical student I have been inundated with facts, studies, theories, and advice on burnout with many of them talking about the importance of empathy in the practice of medicine. I have been taught that to feel empathy; you need more than to just feel sorry for a patient and their situation, as that is sympathy. You need to put yourself in their shoes and vicariously experience what they are going through and the feelings attached to these experiences. I found this to be a major contributor to my own personal burnout, particularly when I was doing my psychiatry rotation. I truly opened myself up to what the patients were experiencing and I tried my best to understand why they felt the way they did. Well, as you might expect, this led me to feeling terrible. Many of these patients have lived incredibly difficult lives, to say the least, and one can understand why they feel the way they do. The entire month was spent fighting back all of their pain and suffering because I was doing my best to be an empathetic student, I was doing my best, to feel and understand their pain. It was not until one of my emergency medicine rotations, where I personally bore witness to extreme tragedy, that I was able to take the next step and understand what it means to be compassionate, and not just empathetic.
The story starts at 5:45pm when EMS was called to the scene of an unresponsive child. They arrived within two minutes of the call and found a child on scene that was apneic and pulseless. They immediately started bagging and compressions while they loaded the child into the medic for immediate transport to our facility. We got a call that there was a pediatric arrest on the way and the feeling in the department changed instantly. There was a flurry of calm, coordinated, and deliberate actions by all those who were involved in the case. The team of nurses discussed their roles, respiratory was standing by with a ventilator at bedside, pharmacy went to work drawing up pediatric doses of medications, medics were ready to take over compressions and start IVs, the residents confirmed everyone's roles and were prepared to get an airway and take over the resuscitation. As a student, I stood by the resident in charge, and bore witness. The room was nearly silent, only quiet background chatter, and the energy was palpable. Fear, because everyone knows how much is on the line and any small mistake might take away any hope present in the situation. Purpose, because moments like this are why members of the team go into not just medicine, but emergency medicine. Discipline, because everyone in the room has practiced their roles and have done them countless times. Resolve, because everyone on that team knows that they are up to the task of giving this child another chance at life.
Within ten minutes of arriving on the initial scene the medics made it to the department. When they entered the resuscitation bay CPR was in progress and they immediately began to tell the story. It was unknown how long the child was down or what caused the arrest, but parents saw the child resting an hour prior. In a flash the team went to work. Intubation, IVs, meds, labs, everything seemed to happen almost instantaneously. I stood there, watching the team work, taking it all in.
Almost as quickly as it had started, the flurry stopped. There was asystole throughout, no response to medications, and foreboding blood gasses. At 6:27pm a two year old girl was declared dead. The team went back to work with their other patients and the loss was felt throughout the department.
When the news was delivered to the mother her wails were heard throughout the emergency room. Before that day I had never heard the sound of true loss and despair, but I will never forget it. It was the kind of sound that echoes deep into your soul and cuts at your foundation. She was rightfully distraught; one moment her baby was peacefully resting, the next, gone. All of the hope and potential of that young life disappeared, just because of a freak accident. The looks on the family’s faces as they realized their youngest was no longer going to be there is indescribable to those who have not witnessed it, and unmistakable to those who have. Even with all of the loss and despair, I did feel hopeful for the family. Throughout the shift, members of their community flooded into the department to show their support and love in ways not often seen in our society. Their love and kindness was palpable and felt by all those around them.
Often times while on rotations I have felt like I was on my own little boat floating away on an ocean of knowledge that I wish would just stick in my head and emotions I wish would not. After witnessing all of this happen, I was flooded with thoughts and feelings. There was a deep and profound sadness and loss. I usually do a good job managing it all, but this was no usual time. After the case a resident came up to me and asked how I was doing. I said I was OK, and she followed up with “ARE you OK?”, and in that moment, I knew I was. With that question, I knew it was OK to feel awful, to feel that loss. I also knew that she felt the same, that the nurses felt the same, and everyone else there, felt the same. I knew that the members of the team at that hospital show true concern for the well-being of each other, and at that moment I was also a part of their team. I was reassured that, while things like this happen in the department, a good team shows their support and allows you to be vulnerable.
After we allowed ourselves a little time to reflect, we started seeing patients again. Our next patient was a kid around eight years old who had a FOOSH injury to his left arm. It was broken and needed to be relocated before casting and outpatient management. He and his parents had been waiting for quite a while to get this taken care of, but were very understanding as they had heard the commotion in the department. We had all of our material ready and were sedating our eight year old with ketamine. He was about as goofy as any kid being sedated with ketamine can be, and his parents were a joy to have in the room to help calm him further. The whole situation could make anyone crack a smile. While I was bearing witness to this event I was filled with a profound feeling of love. It came out of nowhere and was almost overwhelming, but because this event was so perfectly contrasted with what we had just gone through, I was looking at it through a different lens. A lens that was happy to see a family interacting and showing love for each other. I felt a deeper understanding about what it means to not just be empathetic, but compassionate. For me, compassion is moving past knowing and feeling someone’s pain, and going on to meet that pain and suffering with love. I saw a goofy kid, with boundless potential, and a loving family. He opened my eyes to understanding this is what is meant when we are told as students we need to treat every patient as a person. We need to see every patient as someone with their own history to tell, who started out as a goofy kid. We need to realize and remind ourselves that everyone has lived a life filled with setbacks and hardships. As small as a broken arm and as large as the loss of a child, we all have our stories to tell. As clinicians we need to recognize that every patient we have seen and will see is a person and we need to love them for it, regardless of how easy or difficult they make it.
Prior to this experience I thought I knew how to show compassion to those around me, but this girl left a profound impact on who I am as a person. Although the loss of anyone is difficult, and the loss of a child can cause immeasurable pain, I’m thankful I was there to receive her parting gift to this world, one of compassion and love. Because of her I will be able to spread my understanding to those around me, and comfort those in the future I will one day have the opportunity to treat.