The minutiae of clinical work intrude upon me at all times. The ping of an email announces a new message asking for a prescription refill, an urgent appointment, a question to be answered. The anachronistic vestige of the medical profession beeps angrily at me when the hospital operator pages me to call the pathology laboratory because of a mislabeled specimen. The yellow bar on the electronic medical record flashes an inescapable reminder that I have results to follow up on. In the clinic room with a patient, I struggle to remain focused as my eyes drift to the clock that relentlessly ticks away and into the next patient’s appointment time.
The next email awaits. The next page awaits. The next patient awaits. I rush through my day, hurtling from one encounter to another, putting out one fire and jumping to the next, pivoting from distraction to distraction. My attention remains fragmented, and I do not approach the end of the day with a sigh of relief but rather with mounting dread for the notes I must finish, the orders I must sign, the care plans I must manage.
No one entered medicine to stare at screens daily, but that is the majority of what I do. The patient appointments that comprise my day generate far more screen time than patient-facing time. The joy of my work centers around the time I have with patients, but often, the frantic pace of clinical care precludes leisurely conversations and opportunities to understand what makes my patient a human instead of just a patient. Each additional minute sitting in front of a computer drains me, but each additional minute I spend with a patient beyond the time allocated means that I will have less time for the next patient, the next email, the next page. This imbalance between what nourishes me and what exhausts me makes me question my career choice on many days.
But there is one place where time and distraction do not exist, where I feel insulated from all the external forces that demand my attention: the operating room. The sanctity of the operating room, with its sterile white walls, harsh luminescent lights, and gleaming trays of metal instruments, permits me no distractions. My pager is turned off, my phone is silent, my email is ignored. Here, no one can reach me. Here, in this moment, I create a sacred compact with my patient: I am here, just for you.
That singular focus is unusual in a world overflowing with distractions that constantly erode the intimacy of our human connections. When was the last time someone truly saw you, heard you, touched you, without the reflection of a screen imposed in between you or a plethora of interruptions shattering your time together? In today’s fragmented world, that singular focus is a gift, both for me and for my patients. It harkens back to a time when my predecessors made house calls, cared for entire families, and thrived on the sense of connection and compassion that remain the foundation of medicine. It fulfills a need, both for me and for patients. It reawakens my compassion for patients and clinical care because compassion flows best for me without any distractions worrying the edges of my consciousness. It reawakens my compassion for myself; that I am the type of physician I want to be, that I abide by the excellence in which I was trained.
With nothing between us, I see patients for who they are: human, vulnerable, and often frightened. With nothing between us, the patient-physician relationship becomes sacred again. Day after day, my patients and I connect, clasp hands, and exchange reassurances. It is odd that in some ways, the deepest sense of connection I feel in clinical care is when my patients are asleep. But it is a sense of connection rooted in a complete sense of trust. Patients entrust their lives, their pain, their bodies to me. To carry that responsibility is an immense privilege, but it is also an immense burden. I bear the burden of human error, which haunts me the next time I step into the operating room.
I watch as their spontaneous breathing stops and an endotracheal tube becomes their lifeline. I watch as they are eased into a living death. I stand by their side as machines force air into their lungs, as the surgical team gently lifts and repositions arms and legs, as the nurse scrubs their bodies to prevent infection. I honor their faith in me as my scalpel slices tissue and fascia, seeking to extract the intruder in their bodies. My patients are silent, but their bodies speak to me. A scar snaking around the belly button warns that I may need to reconsider a traditional laparoscopic entry. A raised slash across the chest reminds me of the urgency of the task; removing ovaries to extinguish the supply of estrogen to an estrogen receptor positive for breast cancer. A faint line curved like a smile announces that children wait for her safe return, just as mine do for me.
Bodies morph into battlegrounds as I struggle with adhesions, excessive bleeding, and abnormal anatomy. I cannot give up even when I feel strained; I find a way to innovate and create solutions. An operation cannot be hurried along. I cannot set a reminder to complete a task at the patient’s next visit. In the operating room, the here and now demands immediate attention. I only exist in the present. Hours pass, and I do not notice hunger or thirst; the hallowed nature of my task supersedes the demands of my mortal body. I can only focus on the instruments and the patient, dredging forth from my mind an intense concentration that I thought long diminished by the relentless race of modern-day life. My hands cannot waver. Each cut, each stitch must be precisely placed, those bodies remind me, because underneath the drapes lies someone’s beloved.
With reverence, I mend what is broken. With relief, I tie down the last knot. For if patients’ bodies speak to me, so too do I speak to them: I care enough to do my best. I remain focused and alert until I set the instruments down, remove the drapes, and the patient takes that first postoperative gasp of breath. I call their families, a distant voice providing comfort and solace, that yes, the surgery went well; yes, their loved one will go home later today; yes, I’m pleased with the results. I forge new connections in that moment of closure. I slip out of the operating room when the patient awakens. The frigid air follows me in a cloud permeated with the smell of antiseptic solutions and the rusty tang of blood. That silent communion has ended; until next time.
Section Editor: Preeti Malani, MD, MSJ, Deputy Editor.
source: JAMA, 2023
.jpg)
.jpg)
