Becoming (And Staying) Human

It’s funny how strictly we label each phase of our medical training. We carefully divide and demarcate each stage: premed, med student, intern, resident, etc. Each step appears as a quantum leap away from the last, as if when the clock strikes midnight on a certain chapter in our lives, we wake up as entirely different people.

This was most apparent to me when, only a month into residency, I found myself in the middle of an airborne medical emergency. A passenger had collapsed in the middle aisle and when the flight attendant put the call out for assistance, the gentleman I had been making polite conversation with moments before kindly raised his hand and offered my services: “He’s a doctor, he can help!” The flight attendant looked relieved and gestured me over to my latest patient.

In the end, everything was fine. I remembered enough from medical school and the CPR classes I’d just taken in orientation week to assess and treat the patient, and it turned out she was only a little dehydrated. But it was terrifying to see just how willingly people assumed I could handle the complexities of a medical crisis simply because I had a couple of extra letters after my name.

(It’s worth mentioning that I am a white male who fits the “classic” archetype of a doctor. There are multiple well-publicized instances where physicians of color with much more experience than I have been turned away after responding to calls for medical personnel on an aircraft.) This problematic disparity needs to be explored in greater depth.

Now, as a second-year resident, I’ve developed a new appreciation for how much I have learned, but also for the limitations of my skills. While I believe that for the sake of patient safety there is a place for some hierarchy in medicine, I try my best to ignore the artificial delineations between myself and other trainees. I am quick to tell fellow learners that I am just a “6th year medical student.” This sometimes gets a chuckle, but I mean it; the only thing that separates me from a newer trainee is a few extra years in the hospital.

Some readers will have heard of the Gold Humanism Honor Society, a national organization that recognizes medical students, residents and attendings who demonstrate qualities of humanistic care. I was fortunate to be elected into the society as a medical student, but at the time I didn’t really understand the significance of the group. It is only now, as a resident, in a position where my commitment to humanism is threatened every single day, that I really understand the importance of humanism.

For many people, the intern year of residency appears in the shape of a “U.” That is, at the beginning everything is fresh, new, and exciting. Gradually, though, about halfway through that year, expectations mount, mistakes accumulate, and fatigue sets in. It takes a lot to climb out from the other side of the “U.”

Sometime around February, when I felt I was hitting the low point of my intern year , a peculiar thought struck me. Drowning under an avalanche of unfinished notes, my pager blaring every minute with another seemingly ridiculous request, I thought to myself, “My job would be so much easier if these patients didn’t keep getting in the way!”

And with that, I had completely forgotten my purpose as a physician. Instead of fighting illness and disease, I was simply a resident waging an endless, eternal war against work. Nurses, administrators, and program directors all demanded more and more of my precious time. I had felt forced to simplify my life into an us versus them dichotomy. I was stretched thin, overloaded, working 80 hours a week with barely enough time to sleep, let alone exercise or study. And the ultimate obstacle preventing me from getting my hundreds of various jobs done? The patient.

I was shocked by these thoughts. I was disgusted with myself. And looking back now, I finally realize why the Gold Humanism Honor Society is so important. Our medical system seems to discourage humanism. In a system built on maximum efficiency that puts horrendous demands on its trainees, the only way to keep up is to categorize the people around us into contrived, artificial roles (medical student, patient, resident, nurse, etc.). Tribalism is rife, and we are quick to vilify anyone we don’t think is working as hard as us (which, as a resident, feels like almost everyone else in the hospital).

It takes a colossal effort to step back from these defense mechanisms, to zoom out and realize that every time we subcategorize the people around us, they become subhuman. It is incredibly important that we preserve our own humanity and the humanity of the people with whom we work and care for.

Now when I see one of our learners standing on the edge of a conversation, I take a step back to corral them into the decision-making process. Instead of referring to these team members as simply “the medical student,” I make an effort to use first names and remember details about their lives outside the hospital. During sign-out, when a co-resident describes a patient I am assuming care for as “anxious” or “difficult,” I try to ignore my preconceptions and approach each as a blank slate. In short, I take steps to “rehumanize” the people who so rapidly lose their identities for the sake of efficiency and tribalism within our vast medical bureaucracy.

So, wherever you are in your training, I encourage you not to limit yourself to your assigned role. While you should be proud of what you have achieved and respect the experience of those with more experience, know that you are not simply the sum of your years. Medical education is not a one-way stream of knowledge, but a dynamic exchange. One of the greatest challenges is having the humility to know that you will never have all the answers.

But this is what makes us human, after all.