Category Archives: professionalism

Learning to Walk the Healer’s Path

–Erik Brodt

Three minutes and thirty seconds remained in the fourth quarter of the Minnesota Section 6A boys’ basketball final. Showcasing a fake plant step, our All-State point guard sends his opponent to the floor again. Dribbling around the flopping contender, number 5 pulls up and sinks a fifteen-foot jumper to put Cass-Lake up by four. But there is a turn of fate. Floating down from his jump shot, our point guard landed on the foot of another player, twisting his ankle inward and sending him to the floor in agony. Hearts dropped with the crowd’s deep gasp. Silence. I gulped nervously as my time was at hand. I composed myself and strolled onto the court to help our star as thousands looked on.

“Three minutes and thirty seconds!” she shouted as I threw myself into my disaster gown. “Estimated time of arrival, three minutes and thirty seconds!”

My hands quivered cold with sweat as my fingerprints formed though my  latex gloves. Confusion rested on my shoulder. I didn’t know what, but I could feel something horrible happening. That day, now eternally etched into my mind, had begun as a splendid day. Each step was light, walking between medicine clinic and the women’s health wardto visit a laboring mother and evaluate a baby I had delivered in the morning.

Wearing a wide grin of connection and accomplishment, I fought to contain the giddy chuckles of becoming a doctor. When all is well, being a doctor is bliss. Pulling the hospital door, it didn’t budge. Puzzling. Why was our rural hospital locked in the middle of the day? My pager sounded, I was needed in the ER immediately. March 21 will never be another day to me. No day will.

As a third-year medical student I performed a nine-month rural clerkship at North Country Regional Hospital in Bemidji, Minnesota. I chose Bemidji to be close to my family and the three largest Minnesota Chippewa Reservations. I am Anishinaabe (Chippewa) and it was the perfect opportunity for me to invest in the Native community during medical school. Little did I know how profound an impact the experience would have on me, especially on the afternoon when a young man entered Red Lake High School, shooting thirteen people and killing eight, including himself.

Reprinted from The Country Doctor Revisited (Kent State University Press, 2010) with permission from the author.

As a medical student completing a 9-month clerkship in a hospital near the Red Lake reservation, Dr. Brodt cared for the victims of a tragic shooting. It was particularly challenging because he had spent summers with his grandparents on the reservation and knew many of the victims and their families. Triaging and treating the patients injured in this kind of disaster is difficult for any health care provider. Because Dr. Brodt knew the families, it added another layer to the calamity. Because the community had just celebrated the men’s basketball team competing in the state finals, the community’s elation quickly crashed with the tragedy.

In earlier posts we have talked about the blurring of boundaries that occur in small communities. Our patients are often our friends. This is both positive and negative. Together the community mourned, but as a nurse or doctor that day, Dr. Brodt and his colleagues had to put their feelings aside and do what needed to be done. I often think of it as pushing a hold button on my feelings so that I can do the A,B, Cs–airway, breathing, cardiac . . . Once the work is done, I release the hold button.  In his essay in The Country Doctor Revisited, Dr. Brodt reflects on how he and the community struggled to heal from that tragic day.

As physicians we witness the best and worst of times in the lives of our patients and the communities we care for. In order to stay healthy ourselves, so we do not become jaded and cynical, it is important that each of us figures out how to care for ourselves. We may see some colleagues turn to alcohol, drugs, too much work or other behaviors that keep them from facing the real issues. Life is filled with good times and bad times and ultimately we have very little control.

Sometimes patients repulse us…

— Lorence Gutterman

I knock, enter the room, and introduce myself. Carter rolls over to look at me, a grimace on his face. I step back as the musty air of his room reaches me, reminding me of my high school gym locker room. I brace myself and ask him why he became a rodeo rider.

“My uncle and older brother rode. I wanted to be like ’em. Doc, you want to try it?” He laughs through his obvious misery as he pushes himself into a sitting position, his reedy legs now dangling beneath the flimsy, gray-checkered hospital gown.

“I’m too chicken to sit on a bucking horse,” I say and place my chair a safe distance from him. Not so far away to be rude, but I need some space.

“Man, what are ya’ afraid of? Thought Docs could do everythin’.” His grin changes to a frown as he crosses his legs.

“Believe it or not, doctors get scared.” What would my colleagues think of me, admitting vulnerability?

Carter shuts his eyes and rubs them. He clenches his jaw. “Can you give me something for pain? I hurt like hell.”

“Of course. I’ll talk with your nurse.” I quickly leave the room to find his nurse who is counting tablets and putting them into a tiny paper cup. I ask her to increase Carter’s dose of morphine. I reenter Carter’s room. The odors have not changed. I return to my chair, the cracked vinyl squeaks.

“Hey Doc, ya gonna get me feelin’ better?” He has returned to lying down.

“I’ll try. Can’t promise you though. Could you control the bronco the first time you sat on it?”

He tries to prop himself up on his right elbow. “Doc, ya never can control that animal.”

“Kind of like your fever, until I know more about you,” I say fidgeting with his chart.

“Those shakes last night, damn! Bounced me around more than any bronc.”

“Fever caused your shakes.” I stare at the plastic bag filled with clear liquid hanging on a metal pole on the corner of his bed. Its slow drip is hypnotizing, calming. I decide to get to know him before I start quizzing him about risks for AIDS. Taking a sexual history has never been a comfortable task for me.

(Excerpted from Hanging on for Your Life and used with the permission of the author, published in The Country Doctor Revisited, KSU, 2010)

In this selection the author appears repulsed by this patient. It may be the patient’s profession, it may be the smells of illness, it may be the patient’s personality. We are human, we all have reactions to patients. My toughest patients are those who are morbidly obese and come in with complaints related to their excess weight. Obese patients are hard to examine. My feelings are real, I can’t get rid of them. The important thing to remember is that I cannot act on my feelings. I need to recognize them, then set them aside and figure out how to meet the patient where he or she is. Likely the obese patient is embarrased about their weight and has been the recipeint of cruel comments. I try to find some empathy for that patient.  Partnering with a patient demands figuring out what if feels like to walk in their shoes–that saying may be cliche, but its a good place to start. Empathy can help me put my repulsion aside. This is part of professionalism. We may have unsavory feelings, but we don’t act on them.

Sometimes to let off steam, we may joke with colleagues and co-workers about a patient or the situation. Be careful about this. You never want to do that in a location where the patient or his/her family/friends might over hear you. Humor helps us to cope, but eventually you need to set it aside and return to a position of empathy.

The author also talks about being scared. Feelings of fear are human too. Sometimes we are afraid and we need to ask for help. However, sometimes we need to set our fear aside and do what needs to be done.

As you spend time in clinic and the hospital you will see health professionals who are empathetic and kind to some of the most difficult and repulsive patients. Watch them, ask them how they do it.