Why is it that our doctors have become so broken? “Physician heal thyself,” or so they say. But it seems we’ve lost the art of caring for ourselves as a profession. It saddens me deeply. Yesterday, Aviva Romm, a skilled midwife/herbalist/author/artist-turned-Yale medical student called me to process the decisions that lie ahead of her. Originally, she decided to go to medical school to become an OB/GYN, so she could add skills and expertise to her already vast knowledge of childbirth and women’s health. Now, in her fourth year of medical school, she is questioning her decision. Somehow, the OB/GYN’s at her prestigious medical school have lead her to question her skill set, to doubt her gifts, and to feel diminished. We’re talking about an amazing healer who has been on faculty at a university, has written many textbooks, and has years of clinical experience. That she should be cast down by the very profession that inspired her to attend medical school in the first place seems horribly wrong to me. What has become of us?
I swear I have posttraumatic stress disorder (PTSD) from my twelve years of medical education. Even now, I sometimes awaken, drenched in sweat, certain that my pager has been buzzing and a woman is hemorrhaging in a delivery room while I sleep through my page. Or I experience the sting of having my medical school professor spewing hateful words at me- “Suck me good, Lissa. Suck me hard, Lissa,” while he rams the suction catheter at me in the operating room. The one and only time I revisited the hospital where I did my OB/GYN residency, I threw up. So it comes as no surprise that this wonderful woman who would add so much to our profession should second guess her decision to become one of us. Frankly, I don’t blame her.
When I think back to what I endured, it sickens me. When I wanted to fly home to attend my grandmother’s funeral, my professor said, “I didn’t even attend my own father’s funeral. Cancer doesn’t take a holiday.” As if that was something to be proud of, some crazy badge of honor signally his dedication to the profession. I remember consciously deciding that I didn’t want to become like him. I wanted to bring all of my humanity to my medical practice, to be competent and professional, but also flawed, compassionate, empathetic, and real. Nobody made it easy to do that, as if the process seeks to weed out doctors with hearts. Until recently, no physician other than my father ever made me feel valued for being whole. Instead, they seemed to revel in what made me feel conflicted. When I came back to work four weeks after giving birth to my daughter by C-section, they cheered my decision to come back so quickly, even though my father’s funeral had been only days before. When I stayed late to see a patient through a difficult delivery- choosing my patient over my daughter, who I didn’t get to see that night, they praised me. And when I finally decided to take some time off to reconnect to my heart, they chastised me. When I told him I was leaving the hospital to take a year off, one senior surgeon said, “We have to train two of you women to equal one man, since none of you know how to work.” Ouch.
Yet that message lives in me still, buried beneath years of undoing my past, of trying to let go of those twelve painful years of medical education. I still hear its voice in dreams and doubts and demons in my head. They are quieter these days, but they still whisper venom. So I don’t blame this lovely midwife-turned-medical student for questioning her choice. Within the ivory towers of her university, she has discovered a nest of kind, appreciative internal medicine doctors who are wooing her to join their ranks. They want her to craft a residency program to meet her needs, to bring her gifts to how she practices, and to pave the way for a new way to care for women. She asked me what I thought, whether she needed to suffer through the pain of an OB/GYN residency in order to provide the kind of women’s health care she wants to practice.
It’s a funny question. On one level, I am eternally grateful to my teachers for training me so well. I know I can handle any OB/GYN emergency that comes my way. I can wield a scalpel, deliver babies, stop hemorrhage, and resuscitate a dying person. And yet, if I knew then what I know now, would I do it all again? Maybe not. Maybe I would hung out with the nutty but sweet psychiatrists. Or maybe I would have joined the ransk of the kid-loving pediatricians. Maybe I would not have gone to medical school at all. But it’s impossible to play the what-if game. I can’t undo the past, and I do have that training, even if it comes with the PTSD baggage I still carry.
Today, I am grateful to be a board-certified OB/GYN, even with all the crap that came with it. But mostly, I’m happy to have met a group of doctors who value my humanness, who respect me more because I am whole. In my new job at Clear Center of Health in Marin County, I share space with a family practice doctor, an internal medicine doctor, an osteopath, a naturopath, a nutritionist, and a psychologist. We all spend an hour with our new patients, we listen to their stories, we pay attention to the subtext of their illnesses, and at the end of the day, we go home to be with our families. The medical director just left the office for a week to attend a funeral, and the naturopath just took off to take care of her sick cat. Maybe, to truly heal others, we must allow ourselves to grieve, to laugh, to feel, to love, to fear, even to fail. Rejecting our humanity, they way they preached to me in medical school, doesn’t help anyone.
So how did I advise the medical student who sought my counsel? I told her to listen to her heart. Regardless of what they teach you in medical school, hearts always know the answer. And I suspect she’s going to make some gentle-spirited internal medical doctors very happy. As for my profession, if she chooses not to become an OB/GYN, it will be our loss.
Tags: Aviva Romm, childbirth, Clear Center of Health, doctor, gynecologist, medical, medical school, midwife, ob gyn, PTSD, women's health
Hi Lissa,
Beautifully expressed! What a dilemma and what a sad state the medical training system is in.
The sort of hazing that goes on in the training of our culture’s doctors is insane.
This sort intensely stressful, and inhumane process would not be tolerated in the corporate world or even the military, (as sick as those systems tend to be also) and that it is the norm in our “healing” training is all the more ludicrous.
Being witness to my wife’s medical school and residency hazing was eye-opening, shocking and sad. It really set the doctors to be on a course for stress, illness, divorce and dissatisfaction as future docs.
So unfortunate that this is the path for those that are called to play such a core role in the health of our civilization. And we wonder why so many people are not well and are dissatisfied with the medical system and so many doctors are stressed to the max that they quit or wish to.
Health is a core reflection of not only the individual but the culture as a whole. A healthy individual is predicated on a health, sustainable culture. And a healthy culture would have as a refelction a healthy health care system. And of course in this utopian vision the majority of illness would disappear and thus not overwhelm the existing health care system as most of us would be living a more sane, balanced life that would lead to optimal health for the majority of us.
Revolution is long overdue!!!
I think it’s so much worse in the surgical specialties. I hope that one day there can be a way paved for surgeons who want the balance of family and friends. I’m fairly certain that the discipline and skill it takes for you all to excel in the operating room doesn’t eliminate your abilities to make family and friends a priority. I’m glad there are some people who enjoy 18 hours in the OR, but it certainly isn’t me. I also think starting medical school a little older and wiser – like not right out of college – provides a thicker skin and better perspective when faced with some of those atrocities you outline. It’s tough to make sense of that and not internalize it when you’re intense and 22 year old.
I actually feel sorry for the mostly men who choose to work extra instead of having a day off, miss their kids’ games and recitals to try the new sexy laparascope… and feel sorry for the kids always asking where Dad is.
It seems our society as a whole has placed its priorities in all the wrong places. Sure, I am the first to say that a job worth doing is worth doing right, but when it all comes to an end, what matters the most? Your health – your spouse – your family. I have tried (and often failed) to put one day/night each week on my calendar that’s just labeled “FF” – my acronym for Family First. Unfortunately, even in ministry, the drive to put in the hours is rewarded while time taken – even just for yourself is done with caution. Lissa, when I read “We have to train two of you women to equal one man, since none of you know how to work,” it made me absolutely ANGRY! How dare someone make such a statement – particularly to YOU (since I know your work ethic – primarily through your mom). I’m sure you know it deep inside, but that statement is neither fair nor true! Your dad would never have said such a thing – he was a great doctor and a wonderful friend. Thanks for reminding me what’s really important. Now, pardon me while I go mark a few more “FF’s” on my calendar.
Thanks so much for your comment, Charles. I know- it made me angry too- especially given my tendency to be such a workaholic. But then anger isn’t productive, right? I had to just put on my duck feathers and let it roll off…
But I hear ya! And I know it’s not just medicine that produces wounded healers. We are ALL wounded healers- whether its ministry, medicine, social work- or parenting.
And thanks for the reminder. I need to put more FF’s on my calendar, I’m afraid.