Legitimate Pain
In Chapter 6, Dr Awdish returns to work and feels empathy for her patients, then returns to being a patient as she has an incisional hernia repaired.
...my education had begun the moment I had gotten sick, and it would likely continue for years to come. Standing outside the unit, I silently hoped for the strength and clarity of thought to unite my experiences as a patient and physician into a cohesive whole, in a way that would honor all I had been through
What comes after is a series of observations and assumptions that challenged me emotionally. The chapter begins as a resident presents a patient who is in the intensive care unit with HELLP syndrome. He gives a one-liner, then pauses and looks to the author for a cue- she has just suffered an eerily similar presentation and everyone is aware of the startling coincidence. He describes the woman’s medical condition in detail, hospital course, and objective data regarding her care, but does not offer commentary on her humanity. The author is taken aback at this mechanical approach, having been in the patient’s position, and prompts the resident for the name of the baby his patient lost. Having failed to know this piece of information, the medical team is assessed:
“They didn’t see her as a person. She was a case to them.”
My mind returns to Chapter Two and the obstetrics resident who came to visit Dr Awdish after her harrowing first night. This resident had another mother under his care die just the night before- he cries and tells her how hard the experience was and as a result of this emotional outburst is reported to his program for unprofessional conduct. Eventually the goal of disciplining him is abandoned, but he plagues the author as a reminder of bad times for years. When I read Chapter Two, I was mortified for that resident - we are told in training how often our patients appreciate to see our feelings, and by having continuity of care with the author he likely felt he was a sense of comfort as a witness to her journey. I have told myself this narrative many times, when seeing a particularly sick patient leave the intensive care unit, when seeing someone in follow-up clinic. It had never occurred to me before I read Chapter Two that someone might see my presence as an unwelcome reminder or that they would feel “A curse was undone” when I finally stopped coming into their lives. Chapter Two was an awakening to me that my feelings are not always needed or welcomed by patients - not nearly as much of an awakening as I’m sure it was to that resident when he read the book.
Later, Dr Awdish has a hernia repaired and has inadequate pain relief the night after her surgery. A surgery resident comes to assess her pain and asks about her previous opiate use. We are trained to do this, to assess someone’s tolerance, because chronic opioid need much more pain medication and can tolerate it without risk of death. The resident is uncomfortable with the amount of pain medication she is requiring and calls in an anesthesia resident to help. Dr Awdish is stung by the insinuation that she is an addict and reflects that while some people may be trying to manipulate doctors, others may be in “legitimate pain” - it is important, she notes, to assume patients are telling the truth.
I’m struck by the amount of pain in this chapter. The pain of the patient who lost baby Charlotte, certainly. The pain of the author, who had her personal health information shared with coworkers and patients without her consent. The pain of that obstetrics resident back in Chapter Two. The extreme discomfort of the ICU resident who met a new attending and immediately presented an autobiographical patient to her. The surgical resident struggling to do the right thing when his training was at odds with the patient in front of him, and certainly his pain when he was reprimanded. The pain of the opioid-tolerant, who come in for surgery and worry about being labeled “addicts.”
To me, it seems, all pain is legitimate. In such a demanding profession, compassion should not just be expected of all but should be granted toward all as well.
Anna Gaddy
Chief Nephrology Fellow
Indiana University