A Finite Reserve

Recently, I got together with two of my good friends from medical school for brunch, and as we shared our experiences, the three of us began reflecting on a specific characteristic that we had noticed among ourselves. All of us were able to establish rapport with many of our patients, and we expressed a genuine concern for our patients and a degree of empathy and patience that was appropriate to our call of duty. However, we realized that this empathy and patience was often not replicated in our personal relationships with friends and family. One of my friends had not had time to spend with her friends because she was so busy taking care of her patients, and another responded that she had a hard time conversing with people outside of medicine because they did not understand the exigencies of her life. I remembered the times when I ran out of patience with my family because they didn’t understand my life, and how difficult it was for me at times to explain what being a medical student entailed.

I still remember a phone conversation a few weeks ago with my mother when I was left sputtering with frustration. I had complained to her how exhausted I was, and she responded by saying that it was important to get 8 hours of sleep. “Of course I know that!” I had replied. But what was obvious to me was that it was mathematically impossible to get 8 hours of sleep when I came home from the hospital at 9pm and had to be awake at 4am the next morning. Of course, she was only trying to be helpful, but the solutions that my parents come up with often aren’t applicable to my life, primarily because they don’t understand my daily schedule. Yet I no longer have the patience to explain the minutiae of my time in the hospital.
As I relayed this story to my friends, the three of us puzzled over why it was so much easier to show kindness and to care for complete strangers who had little connection in our personal lives when it was so difficult to show the same level of generosity for those people who were most important in our lives.

In some ways, it’s easy to have a general love of humanity. The abstract ideas of kindness, generosity, and empathy sound quite agreeable on paper, and everyone would agree that they are all necessary in our interactions with others. Yet their practice is often difficult, and for my friends and me the difficulties were associated not with practicing those characteristics with our patients but with our families and friends. Our patients needed our help, and an element of a power dynamic existed in these relationships: we could afford to be generous because as physicians in training, we possessed a set of skills that our patients did not have but relied upon for the improvement of their health. This reality enabled us to show the best aspects of our characters, and furthermore, our patients’ gratitude and their responses to our kindness acted as positive reinforcement for us to give them even more of ourselves. Our relationships with our patients were established in only one context—that of the hospital—and we only had one role for them—the caretakers. It became easy to fulfill that role because we knew exactly what was expected of us and how to accomplish those expectations.

However, relationships with families and friends transverse the simplistic dynamics that can exist between doctors and patients. When I interact with my family or my friends, I do not have one coherent, clearly defined role. Rather, my relationship with them is fluid and dependent on their definition of my importance in their lives. Moreover, I am not interacting with them in a sterile environment (both literally and figuratively!)—they are real people, with real flaws that often approximate my own and impact our relationship. I also know that they have to love me unconditionally, and therefore, somewhat illogically, I am more willing to let my guard down, be more vulnerable, and show them the side of me that is grumpy after a long day at work, or sad because I didn’t do as good of a job as I expected on a case that I worked on, or angry because a surgeon was short-tempered with me. I don’t reign my flaws in—I allow them to see all aspects of me without wondering if they will allow me to take of them when they see the worst parts of me, as I do with my patients.

I am still struggling with how exactly to deal with this phenomenon; it’s almost as though I have a finite reserve of goodness that can get stretched thin. It’s obvious that a balance needs to be struck and can be achieved, and I hope that as I recover from the oft-brutal world of medical school, I will reestablish those relationships on a basis of kindness as well.

Writing Again

I cannot gauge whether anyone ever read the bimonthly columns I used to write for the Pakistan Post, or whether people just used them for wrapping fragile items that would then be stored in the remote reaches of cabinets (as my parents used to do with the paper before I started writing for it!), so I don’t know if anyone noticed my prolonged silence. Suffice it to say that I felt the burdens of being a second year in medical school, working for a student-run human rights organization, and being an adviser at my undergraduate alma mater were so overwhelming that I felt that I could not squeeze writing into my busy schedule. Now, months later, I am sitting at my desk, unable to read the chapter about trauma and surgical approaches to it because of my unbearable sensation of ennui. I fidgeted in my chair, played with Genghis Khan, my cat, and ate chocolate from Godiva’s before I realized what the problem was: for so many months, I had been reading other people’s writing, without having contributed anything remotely interesting or intellectual in the form of the written word.

Back in October, when I wrote my last column, I felt as though I didn’t have any interesting things to write about anymore, primarily because I was kept so busy that I had no time to think. The demands of medical school were making themselves fully felt, and the pressure to learn everything about medicine faster than humanly possible was building up. For so much of this past year, I felt like an inadequate student because of the sheer amount of information I needed to learn. I struggled both to maintain my sanity and my sense of balance in life, and also to learn the basic scientific material that would become my foundation as a physician. The resolve to maintain my sanity became stronger as I saw my classmates spending 24 hours a day in our medical education building (people actually began to sleep on the couches in the atrium instead of going home so that they could maximize on study time), or ignoring friends’ phone calls in order to cram. It was a whirlwind of a year, but luckily I survived without ever having to resort to sleeping on the couches in public…(except for that one time during Ramadan when I curled up on the couch, so hungry and sleep-deprived that I no longer cared if my professor saw my drooling onto the neuroscience textbook I was using as a pillow). That unfortunate episode aside, I felt a sense of relief as second year concluded without any mental breakdowns .

My initiation into my clerkship years as a third year medical student began this past May. Since then, it has been quite busy, especially because my first rotation is surgery, and so I spend an average of 15 hours a day in the hospital. Over this past month, I’ve seen and experienced things that I could never have imagined, and I’ve done things that probably only Jack the Ripper had done (such as the time when I had to hold a patient’s intestines against one side of his body while the surgeon operated on the opposite side, or when I removed someone’s rib with an instrument that resembled a large nutcracker, or when I used the sharpest surgical scalpel to cut through an infected toe). My intimate connections with the human body have left me puzzled as to how to respond, and I realize that part of this confusion lies in the fact that I have no outlet for my thoughts. The way I deal with all experiences in my life is to talk things through, or write things down, and I realized that I missed expressing the creative aspect of my nature.

So here I am—with a renewed enthusiasm for creativity and the magic of words, a sense of inspiration, and the desire to share those experiences that have left me alienated from the majority of mankind (unless of course you happen to be either a serial killer or a physician). What you desire to do with the written word is up to you, reader. I promise I won’t be offended if you continue to use this column to wrap your fine china for winter storage—I swear my mother still continues to use the paper for that purpose, despite the fact that this may be the only place where her daughter’s name appears in print. Recycle and reuse, she would defend herself if I were ever to confront her, so I grant you the same license.