By Carolyn Roy-Bornstein
Decades ago, I stood before her, scalpel in hand, a shy young medical student, awestruck and trembling. Now I am 65, the age of my cadaver.
Four students were assigned to each donor body. We took turns with forceps and saws – cutting through layers of skin, fat and fascia. We teased apart networks of nerves, arteries and veins. We weighed airless lungs on hanging scales. We worked methodically in sections —limbs, pelvis, thorax — exposing only those areas critical to the day’s work, with the rest of the body kept wrapped in white sheets and clear plastic. Lastly, we unveiled the face. What could our professors have been shielding us from with this practice? Surely not death itself. By the time we viewed our cadaver’s face, we had held her non-beating heart in our hands, our knife edges placed across her cold still chest.
I believe our mentors were trying to save us from our emotions. The message we received was to detach ourselves from this patient, essentially our first one. If we gazed into this person’s eyes, perhaps we would be unable to complete the tasks required of us. The precise incisions, the delicate separation of tissue, might be rendered impossible were we too attached to this figure on our table.
This was the hidden curriculum in medicine, the seemingly agreed-upon agenda. Keep a professional distance between you and your patient. Don’t get too familiar. You may ask personal questions of them – you’re the doctor, after all. You must. But don’t give out any details about yourself. Bonding too closely with your patients will make caring for them too difficult. It will cloud your judgment.
But what if it turns out that the opposite is true? What if the care our patients need is made clearer by listening intently to their story? By getting to know them not just through their symptoms but by how they came to be here—in your office, sitting across from you? Where they live and work, who their friends are? What their deepest secrets or worries might be? What if learning to listen in this way — paying radical attention to the other human being in the room —not only made us more empathetic physicians, but also created meaning in our professional lives? What if feelings were not something to be protected from, but rather something to be embraced and explored – something that could enrich our physician experience and make for purposeful work?
Since the early 1990s, narrative medicine has been studying this very possibility and coming to the heartening conclusion that yes, such deep-rooted human interaction can indeed deliver on each of these promises. As the writer-in-residence at a family medicine residency program, I have learned to use narrative medicine’s principles to create a safe space for young physicians to process their experiences with their patients through literature and gain perspective through reflective writing. We use close readings of poetry to enhance our powers of observation. We write reflectively together, releasing the suffering to which we bear witness every day. Sharing our work requires us to be brave and make ourselves vulnerable, but it strengthens our relationships with each other as colleagues and deepens our connection with our truest selves.
In a recent session, one of the residents wrote movingly about bearing witness to the death of her patient.
“How did it feel to write those words and to share them?” I asked.
“I guess I didn’t realize how much guilt I was carrying for not doing more for my patient at the end of his life,” she said quietly.
We noted the use of the past tense in her words, agreeing that in writing about the incident, she had not only identified the overarching emotion associated with the event, but also was able to release just a bit of it with her words.
Now finally, at the age of my cadaver, I think I understand what she was trying to teach me all those years ago.
Don’t be afraid, my dear. Come closer. Look me in the eye. You will suffer more by keeping your distance, by not allowing yourself to get close, to take chances, to feel. Remember: you will find your meaning once you open yourself, as you have opened me.
Carolyn Roy-Bornstein is a retired pediatrician and the writer-in-residence at the Lawrence Family Medicine Residency program. Her work has appeared in the Washington Post, the New York Times, the Boston Globe, JAMA, Poets & Writers, The Writer magazine, and many other venues. She lives and writes in Maine and Massachusetts.