A good friend and former faculty member invited me to the private prep school where he had taught for thirty-five years to hear one of his former students speak. Now forty-two years old, practicing as a transplant surgeon, Pauline Chen had recently released her first book, Final Exam.
In her opening remarks Dr. Chen stated that she would address a question that she has been asked time and again—can you do a good job as a doctor and still interact on an emotional level with the patient?
Dr. Chen opened with a story—a tale about a young man who developed a type of cancer of the bile duct system. Dr. Chen was part of the team that cared for him. This man eventually succumbed to his disease after several rounds of chemotherapy. He spent his last weeks in the ICU. Although his physicians felt that they had given him the best of care, none of them ventured to visit him during his final days. Dr. Chen was no exception. When a trusted nurse pleaded with her to get involved with his care, Dr. Chen always found an excuse: there were other matters more pressing. (At the time, this patient was no longer on Dr. Chen’s service.)
Dr. Chen spoke about the concept of “aequanimitas” (equanimity) as advocated by the 19th century Canadian physician and humanist Sir William Osler: doctors need to learn to distance themselves emotionally from those patients under their care. Maintaining equanimity allows the physician to make objective decisions in caring for the patient, decisions unclouded by emotions that may arise in the physician himself.
Dr. Chen shared her discovery of John Keats’ concept of “negative capability,” that of learning to accept uncertainty in medical practice, to maintain an attitude of openmindedness in dealing with the patient. Although best known as the English poet who succumbed to tuberculosis at a young age, Keats had trained as an apothecary and surgeon before opting for a life of literature. Dr. Chen suggested that Keats’ concept of negative capability trumped that of Osler’s equanimity.
In closing, Dr. Chen shared another story. This too was the tale of a man who succumbed to a similar form of biliary cancer. But this time, instead of distancing herself, Dr. Chen continued to visit her patient twice a day, taking time to listen to his concerns and to speak with his family. In the end it was the family who gave Dr. Chen permission to grieve at the bedside after her patient slipped away.
Afterwards there were several questions and comments from the audience. One man, a retired physician, complimented Dr. Chen on her touching tales. He suggested that she look upon these as part of a learning curve. “Eventually,” he said, “you will be forced to adopt a position of equanimity with your patients if you hope to survive as a practicing surgeon.”
Although we who practice medicine may wish otherwise, we will experience those deep emotions that surface in our daily dealings with patients. Practicing with equanimity will only get us so far. Unless we choose to face our feelings and deal with them in a constructive way, eventually many of us will find ourselves emotional cripples, unable to relate to others in our broken humanness.