Difficult Discussions

“Don’t avoid the difficult conversations for fear of loss. Nothing is gained through avoidance. While you might risk losing if you face it head on, there is also the potential to gain everything too.”

Melody Jean

This week was the first of my surgery rotation. To say I was nervous is the understatement of the century. I haven’t had much experience in the OR and the thought of having someone’s life in your hands is so intense. Talk about stress! I have the utmost respect for surgeons because dang they work hard. I now am beginning to understand why my grandfather, who was an orthopedic surgeon, could fall asleep pretty much anywhere. I’ve definitely been tired!

I’ve found those I’ve worked with to be kind and willing to teach those who are willing to learn. Their patience with my lack of experience has been so encouraging. I’ve had the opportunity to place a suture, move the laparoscopic camera during procedures and have managed not to break the sterile field! I’d call that success. There is also a nurse practitioner on the team who will come to see who’s around if she is going to remove a chest tube or some other cool thing. This rotation more than most has been trial by fire. I appreciate being thrown into the deep end. It forces me to get past my comfort zone and learn something new. Otherwise, I tend to avoid uncomfortable things. Though I don’t plan to pursue a career in surgery, like one of my mentors put so nicely, when else am I going to get this experience? I plan to take advantage of every second.

It’s so easy to get wrapped up in grades, the Match, board scores etc. All of these seem important now, but they truly don’t matter at the end of the day. People will remember whether you’re a good person, how you treated them, and that you did the right thing. When we’re tired, studying for the next test, and trying to plan the next year, it’s easy to lose that perspective. By hyperfocusing on the small stuff, you miss the big picture. Your patient who loves to crack jokes is happy to have a warm bed and food to eat. The patient who doesn’t want to trouble you for more medication for her pain and nausea reminds you of your grandmother.

When visiting a patient earlier this week, I had the privilege of observing our nurse practitioner have an end of life discussion with her and her family. She handled the situation with such grace. She provided the needed information, allowed the family to process what had been said, and when prompted she offered her perspective. Most of all, she provided a space for shared decision making. I was immediately reminded of my grandmother and how she had put off similar conversations for so long, not wanting to burden her children. Everyone was caught off guard. In the end, we didn’t have much time to process what was happening before she passed. In contrast, my mother’s parents had made their wishes known many years ago. Everything was documented clearly, so there was no question what they wanted. Having these conversations and making your preferences known takes such a burden off of loved ones who are grieving and don’t have the bandwidth to make these gut-wrenching decisions. I’m so glad that in medical school we’ve talked about advanced directives and how important they are. These conversations need to occur, no matter how uncomfortable for all involved. The truth is, tomorrow is not guaranteed. We never know when we will be called home, but we can at least help our loved ones by being prepared for when that time comes.