Sacrifice in medicine

Julian Nguyen is a medical student in the Class of 2019 at McGill University

 

Monday morning; flu season. The attending respirologist has spent the whole weekend on call battling the symptoms of influenza, likely caught from one of our many afflicted patients. Swallowing a Tamiflu pill, he tells me how—despite a hectic shift in the emergency room—he managed to complete a major grant application for his next research project. His voice is hoarse from coughing and exhaustion lies around the corner, yet his determination to carry on is unshaken. I admire his fortitude while hating myself for lacking his sense of sacrifice.

Michel Foucault, in his seminal Naissance de la clinique (The Birth of the Clinic), highlights the primordial role physicians occupy in a society predicated on science. He sees in physicians (and priests) “les héritiers naturels des deux plus visibles missions de l’Église — la consolation des âmes et l’allègement des souffrances” (the natural heirs of the two most visible missions of the Church — the consolation of souls and the lessening of suffering). Western society’s obsession with youth and health has elevated physicians beyond mere technicians to all-encompassing healers, increasing the burden placed on aspiring doctors.

As a trainee at a renowned teaching hospital, I have witnessed selfless sacrifice in the name of caring and healing on multiple occasions by peers, residents, allied healthcare professionals, and staff. This dedication is demonstrated in many ways: the meticulous researcher determined to push the boundaries of science; the nurse holding a grieving family member’s hand; the activist doctor penning an open letter denouncing discriminatory practices toward Inuit families; the medical student forgoing her first Christmas dinner to work a shift in the birthing center. “Those burdens are what make medicine holy and wholly impossible: in taking up another’s cross, one must sometimes get crushed by the weight,” writes Dr. Paul Kalanithi in his memoir When Breath Becomes Air, a poignant tale of life, death, and the meaning of caring.

Meeting the lofty ideals set by the myth of the healer requires true devotion, especially in an environment where excellence is viewed as the norm, and the work required to fulfill these expectations may sometimes seem unrealistic. We try to emulate the best qualities of the numerous role models we meet on a daily basis, our self-esteem deteriorating as we fail to live up to examples with over twenty years of experience and hard work behind them. One day, it’s the brilliant researcher; the next, the caring listener, the astute clinician, or the charismatic policy-maker. The path to forging one’s healer identity is fraught with uncertainty. Who do we wish to be? What is our best skill? Where do we want to work? Whom do we wish to serve? Caught in the turmoil of ever-changing rotations and hospitals, isolated from our peers working on different services and shifts, sleep-deprived by early rounds, striving for a finely crafted curriculum vitae to pursue our dream residency... there is little time to reflect upon these crucial existential questions. There is only one constant: sacrifice is expected, required, and admired.

This sacrifice is not truly “selfless”; doctors hold a privileged position in society, complete with prestige, power, and a comfortable salary. Caring also comes with a tremendous material cost for society. The public’s growing outrage over physician remuneration has left the profession holding tightly to an eroding therapeutic alliance built through hard work and empathy, but we must concede there is a delicate balance between our work and the fruits of our labour. If we are to maintain a holistic vision of health, we must ensure citizens benefit from adequate services throughout a continuum — not just when they are sick and require specialized care. We must also be consequential in our goals and politics if we do not wish to alienate our patients as we tend to their needs.

This comes with great difficulty; since we have sacrificed so much to become healers, we naturally expect compensation for our dedication. This pattern starts early: medical students — at the bottom of the medical hierarchy — are expected to work long hours at the hospital, study at home, pursue research, be leaders in their community, and stay healthy and enthusiastic throughout their training. Our remuneration is the satisfaction of adding that hallowed title — Doctor — before our names. Though the goal is noble, many lose themselves in the process. Choose wisely your time spent with friends and family; spend less time pursuing art or reading philosophy; forgo your usual workout regimen; don’t even think about going out this week... these are all dictates we consciously or unconsciously follow as we move forward in our training. Not only do our activities change, but also our personalities — we become more anxious, irritable, and competitive. One landmark study even showed that empathy decreases as trainees advance through medical school, especially in their clinical years. Isn’t it absurd that in the process of becoming healers, we may lose some of the defining attributes sought in humane caregivers?

Caring is a fundamental human interaction; we gain then lose the ability to perform it in a graceful arc. We are cared for at birth, care for others throughout life, then end our lives once again being cared for in our waning days. We do not shoulder this burden alone; as our knowledge about health and disease has grown, we have tasked individuals with mastering the art of caring. Among these, physicians stand at the top of the hierarchy; earning the most credit and money for their work, the cost of caring seems inconsequential for these upper-middle class professionals. But dig deeper behind the impeccable white coat and you may find a medical student who learned to sacrifice youth, time, health, and even empathy to reach their goal.

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