Michael Attas: Lessons learned from the loss of a special patient

Waco Tribune-Herald (TX) - Tuesday, February 7, 2012



I remember the first patient I became attached to and who died like it was yesterday. I was an intern and was like most interns — a combination of insufferable cockiness and arrogance, which was only a mask to hide the fact that I was scared out of my wits most of the time.

I knew a lot of facts, but had not yet had real, live faces that depended upon me for life and death and wisdom.

I was firmly entrenched in the model of medical education at the time and the mantra was really quite simple. Learn the facts. Practice good medicine. Detach from the outcome. Move on to next case. Seems simple.

Yet I broke every rule in the book with my patient. She was the wife of the dean of the dental school, a very beautiful and loving woman with a tremendous family.

Her children were my wife’s and my age. We all became close and I became sort of an extended member of their family.

She had a rare and fatal form of heart disease and we knew her time was limited. It seemed so terribly unfair, and we were all devastated and heartbroken.

Yet we broke the boundaries, and we shared bread together with lovely, long meals. We laughed and told stories. We prayed, we wept, we drank wine and we waited.

Next-door neighbors

My wife and I moved to a farm next to theirs, and her son and daughter-in-law became some of our closest friends. Our son and her grandson were born weeks apart. And six months after her diagnosis, she died as we knew she would.

I had never experienced anything quite like this. I felt like a failure and that I had let her and her family down. I was bereft, drowning in self-pity and regrets and a sense that I simply was not prepared for a life of ongoing loss and pain that lay ahead of me in medicine.

I wanted to quit.

My chief of cardiology was a gentle, wise, Jewish physician from Poland who had escaped the horrors of the Holocaust and was instrumental in the development of American cardiology in the 1950s and 1960s. He wanted the facts and yet he always listened to stories with the art of a natural storyteller himself.

He knew I had gotten close to this family, but his inquisitive and brilliant mind also knew that her disease had something to teach us in order to help save lives in the future. He insisted I go to her autopsy, despite the fact that I was an emotional wreck.

I rebelled.

“I can’t do that . . . Please let someone else go there to examine her heart and get the information we need.” Take this cup from me.

But he wouldn’t let me. He knew I had something to learn there, and it was not only about the science of the disease at hand.

So I went and held a still, quiet heart in my hands in death that I had held in life when it was filled with warm blood and beating with vigor. I felt strange, sort of like a traitor.

Respect and love

But gradually that sense was replaced with warmth, respect and love as I realized that her ongoing gift to me wasn’t limited by what she had taught me and what I had learned from her and her family.

We became connected once again, even beyond the boundaries of death. And I finally began to see a glimpse of how to survive in the world of medicine and loss. I began to see the detachment I had been taught was a shallow way to empty lives of meaning and turn patients into a number or a chart.

It made them dead and lifeless before their time.

I learned that it was fine to get hurt, to weep, to be sad and to mourn. And that there is a time also to let go, to learn, to love with memories and to take what we have been given and move forward.

Sure it hurts. So what? What would life in medicine be if we didn’t allow ourselves the risk and gift of loving and caring?

After the dust settled emotionally from that case, I knew there was no turning back for me. I knew I had finally seen a way through the fog in which I was trapped.

I understood for the first time that while I was committed to sound science and wonderful technology, I also had to listen to stories.

I had to weave the stories I hear into my own life and experiences, and learn what patients often have to teach us. I learned it is perfectly acceptable to grieve, to become wounded and to mourn in medicine.

Yet I also learned that it is survivable. One makes it through. The more painful death for me would be to shut down emotionally, to “self sterilize” to not feel anything.

And that, as I have seen in so many, leads to the most painful death of all. It leads to a soul-empty medicine, one devoid of ultimate meaning even in the presence of death and loss.

Dr. Michael Attas is a Waco-based physician, a medical humanities professor and an Episcopal priest. His column appears bimonthly. Send email to Michael_Attas@baylor.edu.

Section: accesswaco
Record Number: 17658440
(c) 2012 Robinson Media Co. LLC - Waco Tribune-Herald

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Michael Attas: Lessons learned from the loss of a special patient

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