Perhaps it was growing up with Chris that fostered my ease
with those conditions we cannot cure. Surely we knew early on that my brother’s
developmental delays would not melt away; there would be no fix-it pill, no
miracle procedure, and he would grow up to be a true man-child: young at heart
and of mind. We adjusted in hundreds of tiny ways so that his—and our—lives
would be the most full.
Years later, in medical school, a speaker asked our class
how many of us would like to save a life. We tentatively raised our hands, our
eyes flicking uncomfortably for a census of our neighbors’ responses: Was this
a trick question? The teacher went on: What does that look like to you? What
does it mean?
It was our first formal lesson in medicine’s ambiguities,
crafted to wake us to the assumptions and desires we each bring to the bedside.
For me, “saving a life” raised specters of adrenaline and procedural heroics,
neither of which were my kin. And the eleventh-hour diagnosis—while no doubt
satisfying—harkened to television melodrama in my mind. So I must confess: when
I raised my hand that day, I was not entirely earnest. Of course, if given the
chance, I would run the code. But I had come to that classroom seeking a
quieter type of patient encounter that existed in gray tones rather than black
In medicine, we each have to understand our style of “save.”
My husband is a surgeon, as is my father. Much of their satisfaction with
medicine and their connection with their patients lies in “the fix”: the
ability to tangibly and physically correct what ails the patient.
I find purpose in helping patients weave their lives around
what we cannot cure. As a general internist I get to be a teacher, a scholar, a
social worker, and a social innovator. A stoic power exists in maximizing
quality of life. But for me to help a person do that, I must understand that
person—her hopes, her responsibilities, and what she needs from me, her doctor.
With my patients, the real work lies in uncovering the
context of their illness. We heal what we may, but just as importantly we wrap
their lives around that which persists. Here knowledge’s power stands strong,
and the role of doctor as teacher is vital: patients may regain some degree of
control as they come to comprehend their illness.
I challenge myself to sit down with each patient fresh and
without judgment. I challenge myself to hear not just the story, but also the
questions swirling underneath and above it. Indeed, part of the craft of
medicine is inferring what the patient needs from us, both in terms of reaction
and results. Above all, I challenge myself to find ways to communicate with
those patients—like my brother—who are “hard” and may not tell their stories in
the ways we are trained to hear … or who may not be able to tell a story at
all. I have found that often, for these most vulnerable patients, their primary
care doctor is one of a precious few communicating that their health—their
life—is important. And though it took me a while to see it, this may be its own,
no less urgent, type of “save.”
Heather Cassidy earned her medical degree at the University
of Colorado School of Medicine. She is a chief medical resident in Brown’s Internal
Medicine residency program.