A doctor’s dignity

I spend the holidays giving baths to my mother. Crouched on a low stool in a bathtub, she allows herself to be cared for in this most intimate and vulnerable of ways. Over the years her congestive heart failure has led her to a point where she can hardly muster the energy for self-care. The task falls to me, and each time she exclaims: My poor doctor daughter, reduced to tasks like this! Kawawa ka naman.

It feels embarrassing and wrong that the woman who raised you—who nursed you through everything from a broken heart to viral diarrhea—should be seeing you through the lens of society, but there it is. While doctors are still disparaged with accusations of incompetence or coldness, it remains that in the Philippines there is a certain inalienable prestige in being a doctor.

It’s a double-edged sword, both attractant and repellant to the pursuit of medicine. On the one hand we are elevated above peers who chose less “prestigious” careers, recipients of awed compliments in large gatherings: Aunts and uncles are suddenly calling us “Dok” rather than by our childhood nicknames. On medical missions we are treated with an attentiveness normally reserved for politicians or celebrities. But on the other hand, for junior doctors especially, the expectations that come with this prestige can often be unrealistically high, and even minor mistakes can seem unforgivable. In any case, our profession has been elevated to a certain god-like degree where certain tasks—such as bathing my ailing mother—seem, to a point, beneath our dignity.

It’s easy for us to get caught up in the idea, too. It’s an insidious process: Somewhere down the line, on our journey from hapless medical students to full-fledged physicians, we become convinced that our time and attention are more valuable than other people’s. Residents and interns battle with nurses and other people on the healthcare team to define what parts of patient care are performable by the latter, and what select tasks are the exclusive province of the former. In an era where the average sit-down time between patients and doctors has been reduced to less than seven minutes, we have become convinced that our time and skills are reserved only for elevated things, and somehow we’ve managed to convince other people, too, like my mother.

I joke with her that when I was an intern in a public hospital I used to do everything under the definition of “dirty work,” from draining urine to changing patients’ gowns to fanning distressed children in the heat of the ER. I joke that at this point nothing is beneath my dignity.

However, I’m forced to wonder what happened to change the definition of “doctor” so drastically, that we should have become so far removed from the image of doctor as friend and comfort-giver; that the daily and intimate care of patients should somehow be seen as alien. In training, a peculiar time when we endure most of medicine’s hardest tasks and appear to reap the fewest of its benefits, we are always pressed for time. We compete with ourselves to see how fast we can do rounds, how fast we can close a patient’s skin after surgery. We become impatient with delays and take as many shortcuts as we can without compromising a patient’s condition, thus spending less and less time at a patient’s bedside or across a consulting table.

In internship, I met a classmate who changed my perspective. By then my classmates and I were able to do history and physical exam, to collect blood samples and to insert intravenous lines in new patients in under five minutes. The results weren’t pretty—more often than not we manually tore medical tape we used to attach IV lines because it took too much time to cut—but they worked. Yet here was a new co-intern, taking his time cutting pieces of medical tape and tenderly using them to affix the IV lines, all while everyone was busy trying to attend to as many patients as possible. Annoyed, I hinted that time cutting tape was wasted time, that it didn’t matter what the results looked like. He looked at me calmly, said, “It matters to the patient,” and continued to tidily fix the IV line while chatting softly with the expectant mother.

It’s a lesson I’m still learning. I think of him often these days when much of my time is dedicated to the care of a patient’s wounds. Sometimes the task feels tedious and unnecessary since we could be doing more “important” things.

Experience has convinced me, however, that the care of wounds is not just a necessary task for the patient’s wellbeing, but a desirable one for the physician’s own. In classes on the “art” of medicine, we’re taught to lend a personal touch to our interactions with patients. It doesn’t get any more personal than the care of wounds, such as those coming after surgery: The careful peeling of the existing dressing, the assessment of the wound, the meticulous cleaning and covering with new dressing. All of it taking some time, to be sure, but all of it affording the opportunity to talk with and provide comfort to the patient. It also provides the physician with a reminder that this is the height of his or her profession: to be able to patch up something that was broken. Definitely something that isn’t beneath his or dignity, or anyone else’s.

It’s the same with my mother. I approach bath time now with the borrowed wisdom borne of experiences with patient intimacy and medical tape; I look at the procedure of bathing not as a tickbox on a checklist or as a job that I’m merely condescending to do, but as the opportunity to inhabit for some moments the role of what a doctor was always meant to be, stripped of politics and context: healer, comfort-giver, friend.

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kaychuarivera@yahoo.com