“REAL TALK: Fuel to Keep the Fire From Burning Out”
By: Julie Jackson-Murphy, MD
Excerpt from “Not Enough Said,” a monthly communication to the Emory University Division of Hospital Medicine
When my issue of JAMA comes in the mail, I confess that the first thing I do is go directly to the Opinion section, specifically to A Piece of My Mind. As interesting as the other sections promise to be, I am drawn first to what regular folks such as myself are working out on paper. Recalling Anna Von’s discussion from last month’s Real Talk, I find the narratives in this section to be part of the framework of supportive bridges and safety nets she sees us building. In this corner of the journal, our profession has authorized the construction of a bridge over which we can carry stories that provide moments of recognition and validation.
So, when I turned to the July 11, 2017 (Vol 318, Number 2) issue’s A Piece of My Mind, I was intrigued to find it was called Stories Doctors Tell. Consider it a meta-analysis about the kinds of stories usually featured in the section. The authors looked at the stories physicians tell “spontaneously” in our medical journals. Included in their review were all the narratives from A Piece of My Mind (JAMA), Perspective (NEJM), and On Being a Doctor (Annals of Internal Medicine) published between May 2011 and July 2013. They acknowledge editorial oversight, yet determined that certain themes occur repeatedly, and that there are lessons within the themes. The privilege of practicing medicine, vulnerable patients, fallible physicians, humanity, and flawed systems are the themes that emerge.
Even more interesting, they found specific ways in which these lessons as stories were told, awakenings, quests, rediscoveries, testimonies, hero stories, and laments being the dominant styles. In short, they articulated a form and a function to our everyday story telling that might just allow us to view our experiences as anything but mundane or inconsequential.
A few Saturday mornings ago, I was sitting at the nurse’s station, entering orders for someone with an acute NSTEMI, waiting for the Cardiology fellow to call me back. A medical student, from a few feet away, called out to me and the nurse sitting next to me to help “roll” a patient. She said she couldn’t do it because she had to go see her patient. I looked up to see that the patient she wanted us to roll was a gentleman in a wheelchair directly behind her. He’d run out of steam before he could get back to his room.
The student told us what room he needed to get to, but again, that she just couldn’t do it because she had things to do. Wheeling a sick and fatigued patient to his room apparently was not one of those things. Years of flipping first to the narrative sections of medical journals had allowed me to internalize some lessons to lean on when I summoned my inner Yoda to remind her that she had the force within her to do what was necessary.
Our interaction had all the characteristics of the stories we tell, just played out in the oral tradition. Here’s how I thought about it. I stood at the edge of a crevasse (shout out to Anna again), looking down at a swirling mess of stress. My patient had chest pain, a very convincing NSTEMI, and our hospital’s Cath lab is unavailable after hours. The student appeared capable, yet underestimated her role, leaving me feeling conflicted about having to point this out to her while caring for a patient with a decidedly more critical need.
The unresolved tension of this experience needed a structure to bear the stress and a framework to lead it a meaningful conclusion. If in these moments, we can think, talk, or write about the tension, we can build a bridge that allows us to cross over the crevasse and learn, or even teach, something in the process. Hopefully, we can get to the other side better because of the experience. Here’s what I learned through the themes of our story that morning:
People can seem thoughtless and selfish, often in the places where you least expect them to be that way. Don’t be thoughtless and selfish and don’t permit others to be that way if you can do something about it.
Find the most polite, kind, and authoritative way to get someone to see the value of being thoughtful and generous.
Sometimes you are reminded of what compassion is when you’re confronted with what it is not. At those times, it might serve you well to know that compassion is a value you often have to teach, expect, and reinforce.
Be willing to acknowledge and declare that sometimes our actions, or lack thereof, make us responsible for outcomes, be they bad or good.
There are opportunities all around us that compel us to act on behalf of a worthwhile cause, to speak up when no one else can or will, and to make the time to do so, even when it seems as if there is none to spare.