Medical practice: Reflections on the art of compassion


Cameron Pierce

In the closing scenes of Margaret Edson's Wit the protagonist, English professor Vivian Bearing, lies on a hospital bed dying of advanced ovarian cancer. "Now is a time for, dare I say it, kindness," she whispers. "I thought being extremely smart would take care of it. But I see I have been found out." Her words offer simple but profound wisdom to medical trainees. Yet the most important things can be, it seems, the hardest things to learn.

As the story often goes, I was young and idealistic when I entered medical school. I believed it my Christian privilege and responsibility to attain the highest degree of clinical competency, and to employ it with the utmost integrity and compassion. Yet I, like so many, completed medical training with an abundance of clinical competency, and relatively little competency in the art of compassion. It seems, in fact, as though the acquisition of clinical skill and the development of genuine empathy often move in inverse relationship throughout the process of medical training; as the former increases, the latter decreases. Just why this occurs is a complex question. Yet the unfortunate result is that many graduates arrive at the working concept that the best medical care--or at least the best that they can realistically offer--is limited to the competent diagnosis and treatment of disease. Suffice it to say, this leaves medical care wanting. In failing to touch the whole person--the heart, mind, and soul of that human other--such medical care fails to alleviate suffering in its full compass and, sometimes, where it is needed the most.

As I reflect on my own journey through medicine, it occurs to me that many of my kindest, most thoughtful, and most self-giving moments with patients occurred early in medical training. When medical school gave way to residency training, I tried to resist the jaded attitudes and calloused hearts that are increasingly found there. Yet the flame of compassion dimmed in my practice as well.

It was my experience 'on the other side of the fence'--on the side of a patient--that taught me in a new way the profound power of compassion to touch hearts and alleviate suffering. Sometimes these lessons come from unexpected sources. It had been some 18 months since I had received a significant diagnosis of chronic illness. The unusual plenty of our medical system (compared to so many) notwithstanding, those 18 months had seared into my consciousness the nauseating sights, smells, and experiences of the sickness routine: the time and emotional energy consumed by scheduling, anticipating, and travelling to appointments; the often anxious and interminable waiting in those often unpleasant rooms; the great discouragement and frustration of finally being seen by physicians who were too short on time, too mechanical in assessment, or too limited in personal investment to offer any meaningful help; the queuing up to lie in yet another cold scanner, or to submit to another needle poke under oppressive fluorescent lights. While I am grateful for the care that I have been able to receive, the added agony of these experiences made me take special notice of the caregivers who were, above all, kind. One experience stood strangely above them all, for all its modesty.

Striving to engage in life wherever possible, I was playing pick-up soccer with friends one afternoon in late summer. In a fluke collision with another player, my lower leg took a hard blow. As I examined my swollen and bruised ankle, I knew that the injury was significant. Not believing my misfortune and discouraged beyond words, I made my way to the emergency room, where I would later be diagnosed with a low-grade fracture. It was a gorgeous late-summer evening, and I could hear the joyful sounds of revelling college students near the ER. Everything outside seemed to throb with vitality. Yet it was a world to which I could not relate--my heart was heavy as I entered for assessment. I lay quietly in the ER bed, wondering how I would manage another setback. I quietly answered the questions of the medical student sent in to assess me, remembering life in her shoes not so long ago. I surveyed the familiar sights of the ER, where I had so often bustled about in past years, and instinctively formed differential diagnoses as I heard patients announce their complaints at the triage desk.

As I was wheeled to the radiology department, I noticed a phlebotomist entering the ER; she had surely been paged to draw my blood, and with me absent for x-rays, I knew that it could be a long while before she would return. Drat, more bad luck--this was sure to be a long night. I was wheeled back after x-rays were taken, and I had scarcely settled back into my ER bed when the phlebotomist reappeared. More startling than her almost-immediate presence was the unspeakable kindness that seemed to quietly emanate from this soft-spoken, middle-aged woman. She touched my arm tenderly, and spoke to me in the most caring, dulcet Hispanic cadences: "I've been waiting for you, you know," she said with a smile. I was speechless and almost transfixed by her slow, thoughtful movements, as she arranged her tray and gently drew my blood. As she came to the last vial, she spoke again: "It will almost be over," she reassured me softly. What was she referring to? The blood draw...or something else? I felt an inexplicable sense of peace and encouragement. She smiled, gathered her things, and left. Arrangements for appropriate treatment were eventually made with the attending physician, and I finally hobbled out of the emergency room some hours later.

The sun had now set. Bonfires were lit, music was playing, the air was thick and fragrant, and life pulsed as before. I stopped on the sidewalk and tried to take it all in, tried to make sense of it all. Only 50 yards behind me, just through the doors, were all the sights, sounds, and experiences of medical care--places where countless people like me spend their time hurting, suffering, seeking care. My medical diagnosis and treatment were carried out competently that evening. Yet my heart and soul were touched in a way that I had never before experienced in the medical system. I felt humbled. Phlebotomists are on the lower rungs of the medical system hierarchy; I had called reflexively for their services many hundreds of times before. But in meeting this gentle servant of the sick, I almost felt as if I'd met an angel, or even heard the voice of God himself. I was deeply moved as I stood there on the sidewalk, crying, on that late-summer's evening.

My experience was, I submit, a testimony to the overwhelming power of a caring touch and a gentle word in a time of need. It was the experience of compassion, offered to me simply but beautifully by a woman called to draw my blood. I wish that I could transplant the insight into compassion that I gained that evening into the consciousness and sustained practice of all caregivers, so that more patients might have an experience like mine. The lesson is this: as humans we are whole persons, and we therefore suffer as whole persons. Without compassion, there cannot be holistic medical care. Now and always is, I daresay, a time for kindness.

Source: Marketplace Institute

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