The Yale Journal for Humanities in Medicine

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Opening My Heart

Dr. Janelle Luk (Yale School of Medicine, Class of 2005) is currently a second-year resident in the Integrated Obstetrics and Gynecology Program at Brigham and Women's Hospital and Massachusetts General Hospital, affiliated with Harvard Medical School.

At times it seems the world is dying of cancer. This is the fourth week of my gynecologic oncology rotation. The patients on the floor are innocent, good hearted, elderly women with diagnoses of advanced gynecological cancer, who initially present with vague symptoms of constipation, bloating and weight loss. Because of their new diagnoses, they usually undergo extensive intra-abdominal operations. Nearly every abdomen the surgeon opens is filled with living tumors, which are invading every organ system.

Today starts as one of my typical mornings. I arrive at 4:30 a.m. in preparation for rounds. My job as always is to collect each patient’s set of vital signs and ask each patient, “Do you have any nausea and vomiting? From 1 to 10, how would you grade your pain?” These past three weeks have been tough. Witnessing the physical and emotional insults that these innocent women undergo in order to survive has been unbearable. I became a doctor in order to learn how to treat patients to make them better, not to witness suffering and dying. Dragging my heavy feet across the freezing hallways, I diligently write down all the numbers and notes for each patient. As I walk the halls, I feel the walls tumbling down upon me. I need rest from the overpowering helplessness, hurt, and sadness. I feel the world closing in on me. Once, I could see. Once, I could feel. Now I am numb. I have become surreal. The vital signs become numbers. The questions become generic. The conversations with patients become formulaic. I become desensitized.

There is a 73-year-old female who comes in overnight with shortness of breath, secondary to pleural effusions and an abdominal mass. I am angry that I did not know she was admitted and now, I will not have a chance to eat my breakfast. Now, I have to rush to collect one additional set of numbers and write yet another note in her chart before the team rounds.

As I walk into her room, I see this patient trying to reach for the refrigerator. I say, “Good morning. I am a member of the gynecologic oncology team who will be taking care of you today. How can I help you?” She says, “Oh...” With an angelic smile on a face full of wrinkles, she says, “I am trying to get a yogurt from the fridge. I am hungry.” With her distended abdomen, the patient bends over and wraps her frail fingers around the yogurt cup. I ask her, “Do you need any help?” She maintains a smile and replies, “Sweetheart, no thanks. I can take care of it myself.” As I walk her to her bed, she looks at me with her tired watery eyes and says, “I am scared.” She starts to break down and cry. I put my hand over hers. I tell her that there is nothing to fear and that we will take good care of her. After I finish the physical exam, I give her a hug. I feel a stream of warmth flow through my heart. Silent tears roll down my cheeks. I realize just how much hurt I have buried inside me. At that moment, I identify with her feelings of hunger, vulnerability, fear, and fatigue. But most importantly, I suddenly feel human again. I need that hug as much as she does. She has saved me.

At times, the pressure of residency can squeeze out our native compassion. I have been too busy dealing in cases, charts, diseases, remedies, and prognoses, instead of people. My interaction with this patient reminds me why I become a doctor at the first place and what life is all about. The emotional sharing and caring that grew to exist between me and my patient touches my heart deeply and makes me a better doctor. I want to hang on to this sensitivity, because I truly believe that actions out of passion and love are the ones that make the difference.

Published: January 4, 2007