The Well-Loved Parts

Christine Montross went from an MA in French Poetry to medical school. It's a strange leap, unless you were looking for someone to write a beautiful, moving book about the process of becoming a doctor. In that case look no further than Body of Work.

I read the book almost two years ago, but one passage in particular stands out. The scene is a hospital room in the early morning hours; Montross and a resident are finishing up a twenty-four hour shift. One of their patients is on his deathbed surrounded by family. The family has, after much deliberation, has decided to disconnect their patriarch's ventilator and let him pass peacefully on. I'll let her tell the rest of the story-

Once an hour for the next several hours, I quietly knocked and entered Mr. A’s room to check on his exhausted family. Occasionally one or the other of them would leave for a tray of vending-machine coffee or to make a phone call to faraway relatives, but otherwise they remained. When four hours had passed with no apparent change in Mr. A’s condition, I took the resident aside. “I know I haven’t seen this kind of thing before,” I said, “but are you surprised that Mr. A is still alive?”

“Not as all,” he replied with a half smile. “In fact, I would have been surprised otherwise, since I haven’t touched his vent since we came on this morning.” I nearly stumbled as he spoke, picturing this family who was emptied off all reserves, awaiting their unenviable, but peaceful, finality of grief. My shock must have been easily recognizable because the resident quickly continued, “Have you seen the paperwork I have to do for every death on this unit? His own doctor will be on in six hours and can dial the vent down then. No one dies on my clock.”

We say we’ll never get there. I say I’ll never be that. But as doctors-in-training, we are reshaping the ways in which he react—in fact we are suppressing universal reactions of fear and grief and horror. Will I able to suppress some but not all? Will I be able to detach from strangers and maintain humanity with which I would respond to loved ones in similar circumstances? But then I am not bound to consider each patient as I would want my brother to be considered? My partner? My niece? The lines blur, and I am left feeling dissatisfied. I do not wish to blunt the spectrum of my feelings, to lose the discomfort I feel in violent movies, to lack empathy at the bedside of a dying patient. I do not wish to hear “stroke” and think of the distribution of vessels to the brain and territories they serve instead of my grandmother’s now-curled left hand and stooped walk. I do not wish to make love to my partner and think, Latissimus dorsi, umbilicus, myocardium. How much of becoming a doctor demands releasing the well-known and well-loved parts of my self?

It seems to me that humanitarian and human rights work poses a similar quandary. If we allow ourselves to be caught up in the horrific things done to people, if we pause for a moment to remember names and faces, then we become emotionally involved and become invested in a battle than may not necessarily be won. Or we take it too personally and are unable to see the bigger picture. But on the other hand if we refuse to reflect on the details, if we shut out emotions we become hardened and have no stake in righting wrongs. Instead it becomes just a job and our only goal is to get through the day.

So where do we strike the balance? How do we maintain our humanity but not wear it on our sleeves? It's a question I'm afraid I'll never quite have a satisfactory answer to.