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.