Science and Suffering
The importance of emotional awareness in medicine
“Although pathophysiology is a science, it also designates suffering in people; the clinician should never lose sight of this.” -Pathophysiology
I’ll be the first to admit I did not read, or even open, many of my textbooks in PA school. The majority of information I absorbed came through powerpoints, lectures, and youtube videos. Except for pathophysiology. When you possess a textbook that thick, it tempts you to look inside.
Pathophysiology lays the groundwork for the rest of the clinician’s medical education. In order to effectively diagnose and treat future patients, it is fundamental to understand how the kidney filtration system responds to different hormones, when the ventricles depolarize in the cardiac cycle, how sound waves are converted into a nerve transmission, the complexity of cellular differentiation and so much more. Partially due to its importance, and partially due to my enjoyment of this class, my pathophysiology textbook had the honor of being read.
Not in its entirety, of course. Luckily I did not have to read very far to glean an important lesson. The first page of the first chapter had a captivating statement which spoke to the starry-eyed student, only on day two of PA school and still convinced she would have time to read every chapter. I, in fact, did not ever possess that kind of time. But I copied down that quote and hung it on the bulletin board above my desk, which should count for something.
That first semester the quote resonated with me, but the following summer it reprimanded me. Year one of three was finished and I had spent many hours at the beginning of the summer reading literature for my capstone research project. While I was no expert on my chosen topic, I felt confidently armed with the knowledge gained to answer most questions directed at me. Most importantly (in my mind) I understood the pathophysiology and was excited to explain it to anyone who was remotely interested.
This was the first summer of the pandemic. Ed and I had spent the spring semester sequestered away in our tiny office completing classes and saying we were stir-crazy by the time July rolled around would have been an understatement. Since my husband is my personal grammerly, his interest in my topic had been, understandably, exhausted. I was bursting with information to share and no one to share it with! Thankfully we had a roadtrip planned and were making a few stops to see people along the way (lucky them, right?).
Cue my dear friend, who was dealing with a personal diagnosis of hypothyroidism. My research topic focused on isolated maternal hypothyroxinemia (IMH) during pregnancy and its potential effects on the fetus. This, too, is a form of hypothyroidism and occurs when a mother has low levels of the hormone thyroxine (T4) without the expected changes in thyroid stimulating hormone (TSH). I will refrain from launching into a further explanation here, but you’re welcome to request my 36-page-literature review for future light reading.
As we visited, my friend was kind enough to ask about the only interesting part of my summer up to that point and I figured she would want to hear all the discoveries I had made, since it related to her personally. I launched into an explanation of what I had learned and didn’t look back, at least not at that moment.
But I had lost sight of the person sitting in front of me with their own experiences, emotions, and suffering. True to her gentle and patient nature, my friend kindly listened to all I had to say. It was not until the next day that she confided just how my words had affected her emotionally. She had enough to process relating to her own diagnosis without me adding on hypothesized risks, statistics and the need for future studies. We were discussing a disease personal to her, a medication with side effects she could experience, and consequences she might face in the future. I had forged ahead with my response to the question seeing her only as an interested friend and not also as a patient. Granted, she wasn’t my patient, but regardless, the information I was sharing should have been delivered with her diagnosis in mind. I had forgotten that pathophysiology designates suffering.
When I sat down at my desk a few days later the pinned quote stared down from its perch on the bulletin board, reprimanding me for being so preoccupied with appearing knowledgable that I had lost sight of my friend’s emotions. That lesson was tough to learn and was significant enough to cement this quote into my mind. The science of the human body is incredible. The interconnectedness of each organ system, hormonal communication, and the balance of homeostasis are topics worth discussing, even with patients. It is just important to remember why they asked in the first place. Be cognizant of their suffering, respond empathetically, and provide them space to guide the conversation so that their questions are answered. Exchanging information is critical, just remember that you are sharing it with a person. Through facilitating this open communication and patient-centered care, we have the ability to truly impact those we daily interact with in a positive way.
