Akina Fay is a medical student in the Class of 2020 at McGill University.
Days after my fourteenth birthday, I was diagnosed with a rare brain malformation and underwent emergency brain surgery to prevent my spinal cord from dissecting.
Days after my seventeenth birthday, my mother was diagnosed with a rare form of incurable cancer.
At the age of twenty, I started medical school and began to piece together the pathophysiological processes that lead to our illnesses.
At the age of twenty-two, my mother died in my arms after a grueling year of hospitalizations, pain and suffering.
At the age of twenty-three, I became a fully functional member of the medical team as a medical clerk.
I have been the patient, the caregiver, and the healthcare professional. I have seen the medical system from all three perspectives. I have worn the non-descript hospital gown as medical teams discussed my case at the foot of the bed as if I did not exist;I have been in the chair next to the bed prepared to do anything to help my loved one; I have been the team member who helps care for the patient in their most vulnerable moments. Through these three roles I have realized what it means to be a professional and healer, and I strive every day to bring my life experiences to the hospital with me to care for my patients in the best possible, and most humane way.
I carry my past experiences every time I meet a new patient. I believe the biggest mistake we can make in relating to our patient is making assumptions about them and having an algorithm be the primary means to inform our ideas and decisions. Every patient is influenced by their background, their values, their expectations and their past experiences. I believe the most important thing I can do as a healthcare professional is to listen to my patient, get to know them as people rather than cases, and identify their goals of their life.
I once met a patient who was in the final stages of metastatic cancer. She was a frequent visitor to the clinic, and nobody could quite understand why she kept coming back. I was told “her pain is under control, so she is not suffering”, an interesting statement as pain and suffering are two very different entities. When I went to meet the patient, I asked her why she had come to the clinic. She told me about how lonely and isolated she felt, as if nobody around her understood her situation and what she was going through. She was afraid to be a burden on her family and friends and did not want to bother anybody to ask for help, so she came to the clinic. The team was right about one thing: she was not in pain. But this patient was suffering greatly. There was no pathophysiological explanation of her symptoms. No amount of textbook reading could have prepared me for this clinical encounter.
She needed me to listen to her, to relate to her, and to empathize with her in order to navigate through her crippling suffering. She needed me to hold space for her, and within this space she could process and express her trauma. As Dr. Awdish so eloquently says in her memoir In Shock, “our ability to be present with each other through our suffering is what we are meant to do. […] Loving each other through the darkness is the thing to look for and to mark. It’s there, in the shadows, where we find meaning and purpose.”
When we start clerkship as medical students, the stakes become higher and the schedule gets busier. There is a constant need to ‘do’ and the power to just ‘be’ often gets forgotten. As healers, our most important role is sometimes to be present for our patients and create a safe space for them to express themselves. And it is in those moments where we make connections and find purpose in our work. In the end, all of our patients will die. This is the inevitable truth of human existence. As such, the way we treat one another while we are alive and the connections we build with each other are what give our lives meaning.
Healing is so much more than textbook medicine. It is so much more than a medical treatment. Healing is not synonymous with curing, but rather with alleviating, palliating and relieving suffering. If we measure our success as healers by the number of people we have saved, we will not survive in our profession. If, instead, we measure our success as healers by the number of connections we have made with patients, the people we have supported through illness and the suffering we have alleviated, we will truly heal our patients and find true meaning in the process, thus also healing ourselves.
Through listening without judgement and holding space for my patients to express their truth, we will find the uncomfortable darkness and shadows together. From there, I will be truly present to support them through their suffering. Once I have tasted their suffering, sat with them in the darkness, and can relate to them as individuals, true healing can begin with us working together as a therapeutic team.
As Paul Kalanithi beautifully wrote in his memoir When Breathe Becomes Air, “Science may provide the most useful way to organize empirical, reproducible data, but its power to do so is predicated on its inability to grasp the most central aspects of human life: hope, fear, love, hate, beauty, envy, honor, weakness, striving, suffering, virtue.” We, as the future of medicine, have the power to bridge the gap between science and human life to make them a cohesive whole.
Beautifully put, Akina, your mother would be proud, as she always was. Xo