Being the Best Doctor: Some Advice

There is much that goes into the education of physicians. It is much more than science; it is also an art. The art of communication; the art of tenderness and love; the art of self preservation; the art of caring. And often that care extends to the patient’s family as well.

The care my dad received while he was in the hospital was excellent. I have no complaints about the technical excellence with which the neurosurgical team delicately tried to preserve his life and ability to live. Life is, or at least for my dad was so much more than being kept alive by machines.

He was an artist; to him to live was to create. It was to experience all the senses and allow them to shape how he saw things and how he expressed them through his art. If he couldn’t consciously process the world around him, that was not life. Accepting a prognosis of deep persistent vegetative state at best was in itself a death sentence. So ultimately we knew when hope of a complete and full, creative, vibrant life for him was waning, that we would step towards saying goodbye. But we would step at our own pace, not to be rushed or pushed by anyone else’s clinical assessment or matter of fact yet unemotionally communicated lack of hope.

There was one doctor on the team who had a bit to learn in the communication department. One of the neurosurgery residents, I thought perhaps the first time I spoke to him he was just totally sleep deprived and coming off of call. I asked to speak to him, and he was not able (for whatever reason) to come to the floor, so I spoke with him on the phone. I gave him the benefit of the doubt, but I was not impressed. Distant, clinical and terse were words that immediately came to mind in describing his tone during our conversation.

It didn’t get any better the next time we spoke, this time in person. It bothered me. The guy lying unresponsive in the bed was my dad and my mother’s husband of almost fifty five years. Not just the guy in 12 with no hope, so get on with the process of making some decisions. He’s not coming back; accept it and let’s get on with it…

But there is a point, and that is that the family needs time to adjust to the harsh reality of imminent death. Once the person is gone, it is too late for anyone else to say goodbye.
The third time I encountered the same doctor I knew in order to be at peace with myself I needed to say something to him. He was in the room trying to elicit basic responses from my dad and didn’t acknowledge me or say goodbye on his way out. So I broke the silence and asked if there was anything he needed to say to me.

“No, no change” is all he said, while pulling off his gloves and shedding his yellow gown.

“Could I speak with you a minute?” I asked.

He nodded and I said what I felt he needed to hear in a quiet and calm voice, one that was intended to communicate concern for him as a (young doctor) who would, as a neurosurgeon, find himself in critical situations with families for the rest of his life. I told him that I had no doubt that he was a technically superb clinician. After all, if he wasn’t, he wouldn’t be in the neurosurgery residency program at NY Presbyterian Hospital. But I continued and stated that I knew what residency training required, as I am married to a doctor, and that one doesn’t devote that much of one’s life to a profession and not want to be the best at it.

I continued, placing my hand on his forearm, and looked directly into his eyes. I invited him to hear what I had to say in the spirit in which it was being said; one of concern and caring for him and his future patients.

“It’s OK to look at us, make eye contact. It’s OK to touch; in fact, we yearn for tender touch in a world of machines and intervention. And we need compassion more than anything else. Compassion that acknowledges the grief, confusion and loss we feel. And I ended by telling him when he was able to incorporate those things he would be the best possible doctor he could be.
And he thanked me.
I hope he will be the best he can be.