“When and how much?” I tried to recall the list of questions for intoxicated patients. A middle-aged man, much older than the demographics printed on the documents I hold, was writhing in pain, vomiting, and sobbing. The paper stated: chief complaint – mouse poison pellet ingestion, attempting suicide. “How and why?” I kept asking. I was his first encounter upon entering the emergency room, a terrified fifth-year medical student at a hospital in Tehran. He didn’t answer any of them as he cried in pain. I gave up on the questions, leaving the papers empty. Then, I hesitantly pointed my finger to his tender abdomen to get at least something on the paper. He suddenly grabbed my wrist harshly: “Don’t let me die! I regret it … I have a kid waiting!” It took all my strength to look back at him – we locked eyes for seconds, but it felt like hours. I later learned that the state I was in is called Tachypsychia, a distortion of time perception induced by high levels of flight or fight neurotransmitters. I had to end it at that moment: “Of course, you’re not dying!” I said. I sounded inappropriately loud and cheerful, and I had no idea what I was talking about. He left a deep scratch while letting go of my wrist. I was clearly dysfunctional with the patient, and a resident took over and pulled the papers out of my squeezing fist, exhausted and disappointed. I stayed there, staring at the scratch, and left with at least one of the questions I had kept asking: Why?
Evidence shows that medical students experience greater levels of psychological distress than their peers, associated with higher levels of depression, burnout, and poorer educational performance. The consequences are students’ decreased empathy, poorer patient care, and ultimately, burnout.
Over the following years, I drifted between slum areas of Tehran as an intern. After graduation from medical school, I moved through villages across the border of Iran and Afghanistan as a practicing physician. Eventually, I moved to the United States to work at Yale as a researcher. In all these roles, I faced an infinite spectrum between life and death, the textbook term of “human suffering.” We all do when we step into health care-related majors and professions without the slightest hint of the challenging, endless journey of pain and healing.
My deep fascination and comfort with written words from my childhood might have been a coincidence when I found myself writing and writing about the patients in an attempt to understand myself and them, from the first death I saw in a CPR room as a twenty-two-year-old medical observer, to years later when I had to decide to stop CPR on a patient for the first time and announce the time of death, standing in a tent at the border of Iran and Afghanistan, a laryngoscope with a broken lamp in my hand. Over the years, sharing the stories of these experiences in writing, both with friends and then with the public via my Farsi-language Instagram account, turned into my primary coping tool. It cultivated compassion from the community and preserved my empathy with my patients.
I’m not the first physician to discover this tool in my medical life journey. Leading institutes have already discussed narration’s potential as one of the effective ways of empowering doctors by turning their conflicting emotions into compassionate reflections on their patients’ and colleagues’ relationships. However, these attempts are scarce and inconsistent within medical schools’ curriculums nationwide and internationally. I’m asking why we are not introducing writing narratively as one of the skills budding health care professionals can use? Why not train health care professionals and medical students in the value of narration at a deeper, integrated, and more extended level from an early stage of education and in an open source framework for all students, regardless of their institutions’ primary resources? Teaching storytelling will allow them to be better observers and empaths, to process more of their intense daily encounters and better consider how they affect them and their peers. Teaching writing and storytelling will also allow them to take an active role in narrating and aiding their patients’ care journey.
On that day with the suicidal patient, I remember carefully observing the scratch mark over the following days, how it stayed, and how it healed. Did I need healing from him and all the dying people I watched before and after him? Had they all left invisible scratches on my skin, begging for a life I didn’t know how to give nor had the tools? I wonder if I might have had a better answer if I hadn’t been left alone with those feelings, if I was trained to translate them into words and had a community, possibly an international one, to tap into and receive support: a borderless platform to share stories and together give the pain a chance to transform into change.
Laya Jalilian-Khave is a physician and a psychiatry post-doctoral fellow.