As physicians, we are constantly faced with a daily barrage of meeting minimum RVU’s, while keeping up with EMR’s as part of the necessary components to successfully practice medicine. This has resulted in a decrease in personal interactions with patients which has caused an increase in physician burn-out and suicides. Attempts to reverse these negative impacts has resulted in instituting wellness and meditation clinics and de-briefings after traumatic clinical events occur. Despite these measures, physicians continue to be unhappy, resulting in many leaving their careers.
Perhaps we need another reminder, one that we once held dear, of our purpose or “why” we chose our profession, a more altruistic view of what the practice of medicine truly entails. Certainly living in the present moment, enjoying the successes of our patients improving health and experiencing positive family interactions are all excellent ways to regain career satisfaction. However, I would like to suggest another option, one that sees the “Divine” in everything we do, from the most mundane to the most intensive care given. I understand that there are some who feel that science is the only reliable explanation for outcomes. Yet we often speak of medicine being part science and part art. Isn’t that “art” but the expression of Divine inspiration?
In essence, it is through my role as a physician that the Grace of an Invisible Divine Presence works and becomes visible.
Therefore, in this spirit of finding an alternative explanation, I would like to share a story about an event that happened recently in the delivery room. As a neonatologist, practicing for 30+ years, I have seen and participated in many resuscitations. Yet this one was different, felt both by me and the rest of the healthcare team that responded that day.
Our team was called to a c-section for failure to progress of a term infant. The mom had an epidural, but was still feeling pain when pinched at the incision site by the obstetrician. As we entered the room, the anesthesiologist pushed two non-opioid meds though her IV to prevent her from feeling any further pain.
When the baby finally delivered, she was clinically dead. There was no heart rate, no spontaneous respirations, no movement. The baby was immediately intubated without difficulty as the vocal cords were wide open, a phenomenon seen only in death. Cardiac compressions were immediately initiated. There was still no response. Epinephrine was given via the endotracheal tube and compressions continued as we ventilated the lungs by means of the endotracheal tube. Finally, at just over 5 minutes, a slow heartrate was detected, but nothing more. Compressions continued until the baby’s heartrate reached over 100 beats/minute, by 10 minutes. However, other than a heartrate, this baby showed no other visible signs of life. There was no spontaneous respirations or movements. The baby was completely limp, devoid of any reaction to environmental stimuli. We rushed the baby to the intensive care nursery to further support her, including initiating passive cooling to protect her brain from any further damage.
At 20 minutes of life, she started to breath spontaneously and by 25 minutes she was actively crying and fighting our attempts to contain her. She was back from being clinically dead, as if nothing had happened and genuinely pissed at all of us for what we were doing to her.
Again, as I have stated before, I have been actively involved managing resuscitations of babies who have required a jump start, but never have I experienced a death that our team was able to reverse in such a manner.
You might ask, at this point of the story, “What does this have to do with trying to deal with burn-out and suicide?”
I believe that being open to a greater power working through us, by whatever name you would like to call it, can help us reconnect to our compassion and humanity with greater clarity.
When we are truly present during patient care, whether in a critical care setting, a patients’ hospital room or during an office visit, the unpleasant necessities of corporate medicine dissipate. At that moment, connecting with another human being, becomes the priority. Obviously, the business of medicine demands to be fulfilled, but the fabricated importance it burdens us with, will no longer exist. Those business requirements will carry far less power over our psyche. Instead, we will revel in the moments spent assisting others in their lives, connecting us, human to human. After all, isn’t that why we went into medicine? This human connection will help us tolerate the onerous non-medical tasks we are responsible for within the practice of medicine.
Furthermore, by genuinely connecting with others, we will be tapping into this Higher Source or Power, this Divine Presence, that will help us heal ourselves and our profession from the impersonal mechanics that we are being subjected to daily. We, as scientists, tend to forget or worse, disregard this as real because it is beyond our capability to measure it, study it or prove it exists.
Could we argue that these experiences are nothing more than compassion at its greatest expression? Perhaps, but compassion, as I understand it, does not bring a baby back from death. Certainly compassion is a vital component that allows this Higher Source to be present within us, but it is only one piece of an otherwise unexplainable phenomena, one I personally witnessed that day.Therefore, I want us to practice medicine, not within the confines regulated by the business of medicine, but instead with the humanity we each possess in our souls, guided by a Higher Source. That is the connection that will help keep us sane and protect us from the ravages of impersonal encounters. If that can’t be called science, that’s ok. In the words of Albert Einstein when describing the mysterious, “I will continue to wonder and stand rapt in awe”, as I continue to enjoy providing excellent patient care as a physician.
Cristina Carballo-Perelman, MD Neonatologist/Author [email protected] @ccperelman www.cristinaperelman.com