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An Oath to My Grandfather

An Oath to My Grandfather A few years ago, in the course of going through some old boxes of memorabilia, I came across a journal I had kept during the first couple months of medical school. “We recited the Hippocratic oath today,” one of the entries began. “Everyone stood up in front of their chairs and said it in unison. I’m so excited to get started with my medical school education!” Reading on, I found something in the text that surprised me. Mixed in with the sentimental and sophomoric musings of an excited young student was an idealism I had forgotten about. “I’m going to become a doctor and buy that building for you,” I had once told my grandfather as a young and impressionable boy. But what does a 6-year-old really know about becoming a physician? “Kussmaul breathing,” I said 20 years later when, sitting in his hospital room, I noticed him starting to struggle for air. Thinking back to the second-year textbooks I had just left behind, I brought back the details of what transpires when the body's organs begin to fail. The lungs, in an attempt to maintain homeostasis, counter the impending acidosis by increasing the rate of oxygen exchange—releasing just enough carbon dioxide to inch the pH toward normal again. Watching the mist from his breath climb up and down the tubing attached to his nose, I held tightly onto his hand—part of me watching his face sink inward like a disappearing mask, part of me thinking about the physiology playing out inside of his body. “Cheyne-Stokes respirations,” I said when he took his last couple gasps of air. It was what medical school was teaching me to do: detach from my emotional core, learn to be calm and collected. But what about the lessons my parents taught me? Listening to the patient, being sensitive to his or her emotional needs? I remember as a third-year student walking into the room of a precocious 5-year-old who had a grapefruit-sized mass in the middle of her abdomen, hardly able to look her in the eye because of the thought of what her disease might do to her. “You’ll be fine,” I told her out of a need to protect my own sense of order and fairness. Despite its heroic ideals and noble intentions, the practice of medicine can strip us of some of our compassion. In the process of becoming the calm and cool physician, a part of us becomes numb to the grief and the heartache that come with the territory. And we do this not just in the patient's best interest, but to survive. I remember, as an intern, caring for an 18-month-old who had the misfortune of having a hose shoved down her throat just before her mother turned on the water. “You can't let yourself get caught up in the emotion of the moment,” my senior resident told me when she saw my eyes start to tear. “Her sodium is 112—if we don't figure out her proper fluid management, having an abusive mother will be the least of her concerns. Collect your thoughts and figure out how to stop her from getting cerebral edema.” So I obliged and became the kind of pediatrician medicine wanted me to become: less emotional, more objective—more clinically competent. Then, several years into my practice, I was asked to come to the home of a family who had taken their newborn, born with a serious congenital heart lesion, home to die. (The parents opted not to have their child undergo a heart transplant.) “Make sure the pathologist handles him with tenderness and love,” his mother said as I walked away cradling his tiny, cold body in my arms. I thought about her words on my long, silent drive to the morgue. How do we as physicians retain our emotional core when bad disease and death lurk around every corner of the hospital? How do we stay psychologically attached to people when tragedy hunts us every hour of the day? Technology has advanced faster than our wisdom to use it, a young, wise nurse once told me during one of my more depressing hours in the NICU. Advice I wish I had thought of the night I sat with my grandfather. No code, no crash cart, no chest compressions—no adrenalin-filled needles shoved into his heart. I cried the night he died too, but not when the nurse came in and covered his body with the bed sheet. I cried when I had to call my grandmother and tell her that his last words had been about her. I also cried when I read the last few pages of the journal I kept for the first couple months of my training. “I hope I never forget who I am,” I wrote, thinking how proud my grandfather would be should he ever get the chance to see me practice medicine. Unfortunately, he never did. And had I known that he never would, the last words he heard from me that night wouldn't have been about the physiology behind the way he was breathing. What I would have told him was how much I loved him, and also how much he had influenced me in my decision to become a doctor of medicine. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

An Oath to My Grandfather

JAMA , Volume 303 (5) – Feb 3, 2010

An Oath to My Grandfather

Abstract

A few years ago, in the course of going through some old boxes of memorabilia, I came across a journal I had kept during the first couple months of medical school. “We recited the Hippocratic oath today,” one of the entries began. “Everyone stood up in front of their chairs and said it in unison. I’m so excited to get started with my medical school education!” Reading on, I found something in the text that surprised me. Mixed in with the sentimental and...
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Publisher
American Medical Association
Copyright
Copyright © 2010 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2010.44
Publisher site
See Article on Publisher Site

Abstract

A few years ago, in the course of going through some old boxes of memorabilia, I came across a journal I had kept during the first couple months of medical school. “We recited the Hippocratic oath today,” one of the entries began. “Everyone stood up in front of their chairs and said it in unison. I’m so excited to get started with my medical school education!” Reading on, I found something in the text that surprised me. Mixed in with the sentimental and sophomoric musings of an excited young student was an idealism I had forgotten about. “I’m going to become a doctor and buy that building for you,” I had once told my grandfather as a young and impressionable boy. But what does a 6-year-old really know about becoming a physician? “Kussmaul breathing,” I said 20 years later when, sitting in his hospital room, I noticed him starting to struggle for air. Thinking back to the second-year textbooks I had just left behind, I brought back the details of what transpires when the body's organs begin to fail. The lungs, in an attempt to maintain homeostasis, counter the impending acidosis by increasing the rate of oxygen exchange—releasing just enough carbon dioxide to inch the pH toward normal again. Watching the mist from his breath climb up and down the tubing attached to his nose, I held tightly onto his hand—part of me watching his face sink inward like a disappearing mask, part of me thinking about the physiology playing out inside of his body. “Cheyne-Stokes respirations,” I said when he took his last couple gasps of air. It was what medical school was teaching me to do: detach from my emotional core, learn to be calm and collected. But what about the lessons my parents taught me? Listening to the patient, being sensitive to his or her emotional needs? I remember as a third-year student walking into the room of a precocious 5-year-old who had a grapefruit-sized mass in the middle of her abdomen, hardly able to look her in the eye because of the thought of what her disease might do to her. “You’ll be fine,” I told her out of a need to protect my own sense of order and fairness. Despite its heroic ideals and noble intentions, the practice of medicine can strip us of some of our compassion. In the process of becoming the calm and cool physician, a part of us becomes numb to the grief and the heartache that come with the territory. And we do this not just in the patient's best interest, but to survive. I remember, as an intern, caring for an 18-month-old who had the misfortune of having a hose shoved down her throat just before her mother turned on the water. “You can't let yourself get caught up in the emotion of the moment,” my senior resident told me when she saw my eyes start to tear. “Her sodium is 112—if we don't figure out her proper fluid management, having an abusive mother will be the least of her concerns. Collect your thoughts and figure out how to stop her from getting cerebral edema.” So I obliged and became the kind of pediatrician medicine wanted me to become: less emotional, more objective—more clinically competent. Then, several years into my practice, I was asked to come to the home of a family who had taken their newborn, born with a serious congenital heart lesion, home to die. (The parents opted not to have their child undergo a heart transplant.) “Make sure the pathologist handles him with tenderness and love,” his mother said as I walked away cradling his tiny, cold body in my arms. I thought about her words on my long, silent drive to the morgue. How do we as physicians retain our emotional core when bad disease and death lurk around every corner of the hospital? How do we stay psychologically attached to people when tragedy hunts us every hour of the day? Technology has advanced faster than our wisdom to use it, a young, wise nurse once told me during one of my more depressing hours in the NICU. Advice I wish I had thought of the night I sat with my grandfather. No code, no crash cart, no chest compressions—no adrenalin-filled needles shoved into his heart. I cried the night he died too, but not when the nurse came in and covered his body with the bed sheet. I cried when I had to call my grandmother and tell her that his last words had been about her. I also cried when I read the last few pages of the journal I kept for the first couple months of my training. “I hope I never forget who I am,” I wrote, thinking how proud my grandfather would be should he ever get the chance to see me practice medicine. Unfortunately, he never did. And had I known that he never would, the last words he heard from me that night wouldn't have been about the physiology behind the way he was breathing. What I would have told him was how much I loved him, and also how much he had influenced me in my decision to become a doctor of medicine.

Journal

JAMAAmerican Medical Association

Published: Feb 3, 2010

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