Heart failure

By Rachel Conrad, MS3

During my months of Internal Medicine, it seemed that every patient who I saw was a victim of kidney, liver and heart failure and had been admitted to the hospital for volume overload. Most suffered from obesity, improper nutrition and harsh lifestyles. Many struggled to adhere to their medications at home and were routinely admitted for management of chronic conditions.

One patient was so obese that she could barely move; I feared she would fall off the bed while I attempted to examine her. Her whole body was swollen. Pressing fingers into her legs left deep prints, and water rattled in her lungs as she breathed. The records showed she was frequently admitted to the hospital through the emergency room and lab results suggested she had trouble properly taking her medications at home.

In the team room, one of the residents said, “The residents who saw her last month said she isn’t volume overload, she is just fat and keeps returning to the emergency room.” We had seen the signs of volume overload on her physical exam only moments before; he knew that this statement was inaccurate.

While the dismissal of our patient’s problems disturbed me, working with the patient was exasperating. When I checked on her in the morning and inquired about a routine list of symptoms that we typically monitor in hospitalized patients, she consistently endorsed every symptom that I mentioned. She reported extreme pain and complained about the nurses, the hospital’s food and even the shampoo.

The patient was clearly suffering but I had no sense of how we could help her and I felt completely powerless. The only way I could fathom for her needs to be met required re-designing our entire society.  Blaming the patient for her struggles and dismissing her symptoms were both simultaneously inappropriate and dishonest. I deeply desired to feel compassion for her and hold hope for her healing but had difficulty staying present when I spoke with her. My resentment about the entire situation grew.

Toward the end of my three months on Internal Medicine, I observed how my exhaustion and frustration was impacting my ability to be present and empathetic in caring for patients. I didn’t want to fall into a pattern of detachment and dismissiveness.  Days before my next clinical assignment was to begin, I cancelled my rotation in order to spend time at a Vipassana meditation center.

The guilt and sense of inadequacy that I was unable to handle the intensity of medical school gnawed on me into my stay at the meditation center.  Classmates informed me of the research projects and extracurriculars that they planned to pursue while I was washing dishes, drinking chai tea and sitting in a dark room observing my breath.

Wrapped in an enormous plastic apron and donning yellow gloves while perched over industrial sinks filled with dirty dishes, my fears spilled out before another meditator.  Tears dripped down my cheeks and fell into the brown soapy water.  I shared my shame about needing a break from school and fear that I wouldn’t be a good physician because I couldn’t handle the intensity.

As we spoke, I remembered a story told by the Buddha: A woman named Kisa Gotami whose only child had died came to the Buddha to ask for medicines to save her late child. Buddha said he would heal the child for the price of a mere handful of mustard seeds, but the mustard seeds must be procured from a household that had never lost a family member. Kisa Gotami searched house to house, asking if anyone had died.  She slowly realized that every household had suffered the pain of losing a beloved.

I thought of my medical school friends and mentors and easily recalled times each had struggled with burnout or fear of inadequacy. These feelings are unavoidable on our path and only becomes toxic to us and to our patients when buried.  Alternatively, acknowledging our challenges and confronting our fears can deepen the compassion we are able to offer our patients.  Buddhist nun Pema Chodron said,“Compassion is not a relationship between the healer and the wounded. It’s a relationship between equals. Only when we know our own darkness well can we be present with the darkness of others. Compassion becomes real when we recognize our shared humanity.”