By Bailey Sutliff
This is for the empathetic medical student — the student who chokes back tears in patient rooms during rounds; the student who frequents the restroom after seeing their patients as a way to seek a private space to collect their thoughts (or shed a tear); the student who never missed points on the “empathetic statements” checkoff list during a simulated patient encounter; the student who takes home their patients’ stories and continues to bear that weight while going about their day; the student who cannot remain unaffected by a devastating diagnosis; the student who isn’t able to pretend that these people aren’t people. This is for that student. And one of those students is me.
I don’t have all the answers. In fact, I don’t have any answers. That’s not what this is going to be, although I wish it was. This is an outlet for other students who feel things like I do. You are seen, you are heard, and your feelings are valid. And it’s cathartic for me because frankly it’s not often that I encounter another person that struggles with this to the extent that I do. And this is not just about being an empathetic person. This is feeling the feelings of others so deeply that it can be debilitating — not to the point that it affects my work, but to the point that it affects me. Deeply. Being in medicine, this is a far too frequent experience. And I’m only in my third year.
I have always been an empathetic person. As a child, I would cry if I saw an elderly person sitting alone at a restaurant; however, I think this may be a common experience. But it went far beyond that. My brain begins to create a backstory for this individual which somehow would end up with my picturing the end of the person’s life. I was always thinking about the end. And that has never changed. Everything in my mind is ending–graduation, moving, etc. It is all just one step closer to the end. I recognize this is my own problem and twisted thought process to work out with my therapist, but I feel compelled to share this in case anyone else feels the same way. Because these feelings can be isolating.
Medicine was not real until my third year of medical school. At my university, that’s when you start your clinical rotations. And this is when things became so much harder. All of the disease processes that I was learning about for the past two years came to life. And they were impacting real people. At first I was fueled by the blind excitement that I was actually getting to see patients. I hadn’t thought about the negative situations that I would soon face. I had just come off of Step 1 studying and I was eager to be in the hospital. I couldn’t wait to show my residents and attendings everything that I had been learning. It was my time to shine. The learning curve with rotations was pretty steep, especially starting with internal medicine. But I quickly fell into a routine and just tried to keep up. I was just starting to get the hang of things when out of nowhere, I learned what a rapid response is.
During a rapid response, the patient isn’t actively coding, but they’re acutely deteriorating, unstable enough for medical staff to have a crash cart on standby and providers for resuscitation. I saw my first one called on a 19-year-old man. And I was just trying to stay out of the way, but also trying to learn. It’s a very fine line. I watched our attending command the room and handle the situation with ease. He looked like Superman walking out of there. I just knew the patient would be fine. But then we arrived the next morning to hear that he passed away overnight. I had not had to deal with a death until that moment. I recognize that makes me an extremely lucky person. My first thought went straight to this patient’s father and how he had lost his son. My heart broke for him. Out of nowhere it seemed, he would now go home with a gaping hole in his life and in his heart. These aren’t just patients we’re treating. They are real people with entire lives, lives that are literally in our hands. That was just my first time witnessing it. And I tell this story not to focus on the empathetic side of things, but more to set the scene of my third year.
Onto the next rotation where I was sent to see a gastroenterology consult, the sweetest 91-year-old lady you’ve ever seen. And I already have a soft spot for the elderly. She was surrounded by family members and in obvious discomfort. She couldn’t keep anything down for days and felt miserable. In the softest, sleepiest voice I’ve ever heard, she asked me, “Will you please just put me to sleep…forever…please?” I grabbed her hand. I didn’t know how else to respond to that. I’m just a medical student. This wasn’t the type of stuff that we’re tested on. But I held her hand and I told her I would do everything I could to make her feel better. I told her I would talk to the doctors and immediately go double check on her nausea medication (Zofran) with her nurse. I gave my best comforting look to the family members and stepped out. I went straight across the hall to the bathroom and cried. Then I wiped my tears and went to ask her nurse about the Zofran.
Neurology. I am not strong enough for it – which I learned during that rotation. It was during my week on the stroke team, specifically the ICU. I was assigned my first comatose patient, an 87-year-old man who had a large stroke paralyzing him on one side and leaving him with expressive aphasia. I saw him as soon as he came in, still intubated. He was asleep. Alone. But he looked strong; he was a large man. I did my best exam, reported back to my residents, and went on with my other patients. The next day his wife was present at the bedside and he was extubated. I was eager to do another exam and find out more information. As I asked him questions, he was unable to respond. But he followed commands and knew what I was saying. I knew this was his aphasia and his frustration was palpable. But it wasn’t until his wife began to speak that he started to cry — the saddest cry I had ever heard in my life. A cry laced with frustration and anger. A cry that was the only way he could express himself. The only way that he could be heard. And it was loud. My chest started to hurt. I knew if I didn’t find a way to politely excuse myself soon that I would also start to cry. His wife was rubbing his chest and shushing him, trying to calm him down. I made small talk with her and quickly wrapped up my exam. During that conversation I found out that he was a physician. My eyes watered. I realized he understood everything that was happening to him. He knew how this would end. He knew his prognosis. I told him before I exited the room how much I admired him and squeezed his hand. I headed straight for the restroom, except this time it was all the way down the hall. I couldn’t stop the tears and I was suddenly thankful for my mask. But this time I took a bit longer to console myself. Once I finished drying and fanning my face, it was time for rounds.
Emergency department. Trauma after trauma rolls in. ABCDE. CT. OR. Repeat. Until a 33-year-old man came in following a work accident. His pericardial effusion was too far gone. He couldn’t be resuscitated. I see it this time. All I felt was fear, the sadness wasn’t there yet. I see his body and I’m mentally transported back to the cadaver lab. It all happened so fast it just doesn’t seem real — until suddenly it does. It’s time to tell his family. My resident brought me along. I’ve never been a part of one of these conversations before. Now that I have been, I think it’s the worst part of medicine. He had five family members waiting in a little side room. As the resident updated them on the situation, their lives broke apart right before my eyes – the screams, the jumping, the tantrums – the realization they just lost someone so close to them. I watched as five different reactions unfolded in front of me. Life is so short. Telling that patient’s family, for me that made it real. I felt like I was going to be sick. I made my way to the restroom as usual. I try to escape the screams. I break down. But why am I crying? It felt so selfish. I wanted to call every family member and friend I had and tell them how much I loved them. That’s all I wanted. But instead I washed up. I put my hair up in a ponytail. I walked back to my desk and put my jacket on like a coat of armor — like it was going to protect me from these feelings. I don’t know that it actually did, but it helped me get my job done for the rest of my shift. I finished my cry on the way home at 11 pm.
I really do wish I had an answer because I would share it with you. Writing this piece brought back all of those feelings and they cut just as deep. They say you’ll get numb eventually. I honestly don’t think I will – I hope I don’t. I think being this way is what makes me who I am. It’s what makes me connect with my patients. It’s what drives me to care for them and picture the effect that my care will have on the rest of their lives. And their family’s lives. I don’t think this makes me weak, even those moments when I do have to take a breather and cry. I think it makes me human. It makes me stronger and I think it will drive me to be a better physician in the future. I may carry the weight of my patient’s stories a little bit longer than others. I’ll always take a little bit of each story with me in every patient I see — that’s the best part of medicine. At the end of the day, it’s the patients who build their doctor. I’m glad I’ve gotten to share some of the patients who are building me. And I’ll always have my coat of armor to protect me. But in a year, it’ll be a long white coat.
Bailey Sutliff is a medical student at UAMS. She grew up in White Hall (Jefferson County) and attended college at the University of Central Arkansas where she obtained her bachelor’s degree in biology. In her free time, she enjoys volunteering, traveling, playing tennis, and reading. She currently lives in Little Rock with her two miniature golden doodles, Charlotte and Stella. Ms. Sutliff is passionate about Women’s Health and plans on pursuing an obstetrics/gynecologic residency.