“I learned about a lot of things in medical school, but mortality wasn’t one of them.”
In his latest best-selling novel, Being Mortal, surgeon-writer Dr. Atul Gawande explores the concept of mortality in medicine. Medical innovations have pushed the boundaries of our capacity to heal, but as Gawande argues, “I have seen the damage we in medicine do when we fail to acknowledge that such power is finite and always be.” Being Mortal dives into how we age, cultural divides in elderly care, and the limits of modern medicine, but as a third-year medical student, I found his lessons on hard conversations to be the most resonating.
The hardest conversations I had in my first two years of medical school were with actors. I was breaking bad news in a medical exam room, but so were the thirty other students in identical mock exam rooms at the same time. It must have been an unusual sight, a second-year student in a barely worn white coat bumbling his way through asking if a woman wanted to keep her husband on life support. One moment, the woman in front of me was sobbing hysterically, the next, she was methodically giving me pointers on how to better connect with a crying patient. Our professors and the actors had stressed the importance of empathy, of asking how much the patient wanted to know, and of being careful with our words. My classmates and I tucked away this day in the back of our minds as a nice exercise in how to talk with patients. Surely though, there was “real” medicine to learn, as we buried our heads in our textbooks and practice questions.
As I’m beginning to learn though, “real” medicine, can be found precisely in these types of moments. From my oncology rotation, I wrote about meeting a woman who was faced with the decision of pursuing further treatment and potentially dying in the hospital or going home to spend her last few days with loved ones. What had begun as a simple infection had spiraled into subsequent complications or what Gawande calls ODTAA (one damn thing after another) syndrome. At this point, what she needed more than antibiotics or procedures was her hard conversation. I watched as the oncologist sat down with her and her husband and discussed her options. Having cared for this patient throughout her diagnosis, the oncologist and medical team knew how important going home in the end was for her. Later that day, she made the decision to go home. As Gawande puts it, “Here is what having a hard conversation can do.”
I did not realize it at the time, but her story would repeat itself over and over during my next few months in the hospital. The faces and stories were all different, but countless times the exam room served as a backdrop in which patients and families grappled with difficult decisions. These types of moments never seemed to be easy, but such is the nature of making objective choices in the face of overwhelming emotions. Of all the things I’ve learned in medical school, mortality is one I find myself just beginning to come to grips with.
Read more about hard conversations via an excerpt of Being Mortal on Slate.