He sits expectantly, eyes fixed on me. The wall clock ticking over his head reminds us both that he needs to be on his way.
I am a relatively new clinical preceptor; he is a freshly minted clerk on his very first rotation — psychiatry —and has just spent a few days with our rural geriatric outreach team.
I hesitate.
The medical students before him, who are nearing the end of their clerkship, startled me with their confidence, a degree of self-possession I do not remember enjoying at their stage. Occasionally I detected a hint of jadedness (already!), a mild whiff of something dismissive, providing an uneasy foretaste of cynicism to come. “Toby,” on the other hand, is refreshingly green — his manner disarmingly open and receptive. Newly sprung loose from the classroom into the real world of medicine, he can hardly contain his eagerness as he watches intently for cues as to what he should do. With our elderly patients, he is unfailingly polite and deferential, naturally respectful.
I am struck by a strange pang of tenderness, a protective urge. I fear that what I see will gradually be eroded: worn down by long hours, by familiarity, by time, by inadvertent modelling. In Toby I glimpse something precious and fragile, which must struggle to remain intact and vital after being wrapped in the necessary tough skin of experience.
What tiny drops of wisdom can I possibly administer that will make any sense to him at this stage? What navigational aids will help to equip him for this remarkable journey, where his patients will teach him far more than any of us?
I keep coming back to two thoughts: Honour the trust you have been given and stay curious.
Honour the trust
Never lose sight of the incredible privilege of hearing people’s stories. Our patients dare to reveal to us — relative strangers — their most naked and vulnerable selves. They invite us alongside them in their brokenness and woundedness, to accompany them through their most difficult passages. They allow us to touch them — literally or figuratively — where it hurts the most, trusting that we will not unnecessarily cause further pain.
Never forget that this is a sacred trust, not to be treated casually.
Let yourself be humbled by their courage. Uphold their dignity. Be gentle and trustworthy.
Stay curious
Fight to keep your curiosity alive. It fuels the flames of passion for the work. It will combat the erosion of your creativity and generativity (the ability or power to generate something from within). Without curiosity — about the problem in front of you, the science behind it, the person herself — you will lose sight of what you are doing in this business. I knew I was recovering from the creeping burnout of late residency when I noticed my curiosity returning.
Curiosity about the pieces that don’t fit neatly together (“Hmm, that’s strange….”) leads to new insights and discoveries.
Curiosity about individual patients will keep you seeing them as human beings. It banishes the sense of sameness. You will become jaded when you no longer expect to be surprised … and jadedness is antithetical to a sense of wonder.
Nurture your curiosity. Feed it.
I am no longer talking to Toby. I am talking to myself.
Footnotes
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Previously published at www.cmaj.ca