The first time I spoke of the encounter depicted in “E.B.” was during an interview for pediatric residency. The interviewer, a steely-eyed child abuse specialist, asked – not gently, but keenly – about my most difficult experience in medical school. I was surprised that what came to mind was not the drama of bullet holes and blood in the ED, interviewing a woman my own age chained to the wall of the psychiatric ED, or playing tic-tac-toe with a child with leukemia who seemed well but was expected to die from fungal disease – the kinds of gut-wrenching experiences that we swapped like war stories over beers at the end of a rotation. Instead, I began to describe an older man with epidermolysis bullosa, whom I met in the outpatient dermatology clinic.
During my fellowship, I enrolled in the Narrative Medicine Workshop at Columbia, and found myself coming back again and again to write about encounters with patients that had been breathtakingly brief and profoundly affecting – more than I had quite realized until I sat down to write. During our small group sessions, it was these men and women guiding my hand. I knew just fragments of their stories, but those few shared minutes had changed what I thought it meant to be a good physician. In those encounters, I started to recognize that the space between being a physician and simply being a fellow human was smaller than it seemed in the early, daunting years of medical education.
In Osman Bhatty’s “Clinical Flashback,”the writer, also then a medical student, describes a similarly brief encounter, after he is asked to obtain blood from an elderly patient. The woman asks, “Is this going to help me see again? … Is it going to help me walk again?” Her questions are plaintive and poetic. Osman realizes that sometimes medicine itself has nothing to offer our patients, yet we physicians cannot simply walk away. Reflecting on my own encounter, I think perhaps the first, most human instinct would have been disgust cloaked in pity; the second, to look without seeing. Medical training subsumes those reactions to the clinical gaze, a new way of looking at our patients without truly seeing their humanity, their suffering and how little separates us.
We teach, and are taught, “First, do no harm.” We forget that merely to look upon our patients with the clinical gaze may sometimes do harm.
Amy Caruso Brown is an assistant professor of bioethics and humanities and a pediatric oncologist at SUNY Upstate Medical University in Syracuse, NY. Read her piece, “E.B.” in the Spring 2015 Intima.
© 2015 Intima: A Journal of Narrative Medicine