Wednesday, August 22, 2018

Talking it Like it is: Advice from a HPM Fellow to all the New Interns

by Christine Bridges

The hallways are full again after a short June reprieve. Starched white coats, cleaner than it ever seemed possible bustle through the hallways, making up in speed what they lack in direction. They fill each space with eager anticipation. It is almost palpable. It is the scent of July. Each furtive glance at the clipboard in the elevator fills me with longing to tell them the advice I wish had been passed out with my first pager.

The biggest challenge ahead of you will be communication. Over the next 3-7 years more often than relieving tension pneumothoraxes, performing thoracenteses, or placing art lines, you will be you will be having difficult conversations. You will have to address substance abuse when you find cocaine on a routine urine drug screen in one of your favorite patients, the one who always brings cookies to her appointments. You will find yourself in the ED at 3am listening to radiology explain that the CT scan shows a large lung mass, not a pneumonia. Room 345’s son from California will arrive to the hospital at 4pm on Friday and need to talk about Dad’s pancreatitis urgently. You will have to tell people they are dying. You will have to tell families that their loved one is dying, that their loved one died, that they did not get to say good-bye.

You will be part of sacred moments in the lives of near strangers. You will hear the confessions, the deepest secrets that their own families may never know. You may hold their infant daughter before they do and be the first to tell them her gender. You will give a diagnosis that changes a life, you will be able to say: the scan is clear, the chemo worked, the surgery was successful, he came through. You will hold hands, wipe tears, and you will live in family stories for years.

It will not go well sometimes. It won’t be the first difficult conversation you had that day, it will be the fifth. Maybe you didn’t sleep well, maybe you missed lunch. Perhaps the person with unkempt hair sitting across from you wearing pajamas to their 3pm appointment will question your medical credentials because you look ‘too young to be a doctor’. Maybe this patient has spent more time in the hospital as a patient than you have as a physician, they have more experience with difficult conversations than you do. Your feelings will get hurt. You may stand in a room tightly clenching a stethoscope like a lifeline as you discuss a discharge plan while a fragile patient cries and says you just don’t care about her. You may be sent by your attending to explain to an undocumented immigrant that there are no options for outpatient dialysis for her renal failure. You will be the recipient of gratitude you did not earn and anger that you cannot understand.

I remember the way my own stiff white coat chaffed at my neck, fitting too long in the sleeve as I rounded my first July as an intern. Long sweaty months running to the ER followed, life blurred, lessons became habits and I became a fellow. And now today I want to place one hand on each intern’s shoulder and tell them: It will all be OK. You are not alone. Neither is your patient. There are skills as real as sterile technique. Skills that will carry you through difficult moments. We are not born ‘good with patients’ or skilled with microscopes. The upper level who glides into the room, smiles gently, and leads a goals-of-care discussion acquired those skills because it matters to her patients. She fought for this capability with education and hard work, not with genius or luck.

You can learn the same skills now on your first days, you can practice them in every interaction from the clinic to the OR. You have palliative care professionals who want to join you in your work, to be your ally, to be your patient’s champion. If we can’t be in your hospital we want to be your educators at workshops and conferences. We’ll see you in the halls and elevators. We want to talk and listen.

Christine Bridges, MD is a hospice and palliative medicine fellow at the University of Louisville Health Science Center. She enjoys baking and watching zombie movies with her husband.

Pallimed | Blogger Template adapted from Mash2 by Bloggermint