Your Doctors Are Human Too

In 2009, I began medical school. When I received my medical doctorate degree in 2013, I thought I was already a doctor, only to go through three years of internal medicine residency, then two more of endocrinology, and realize I didn’t even come close.

During the first week of intern year, I often got lost in the alternately chaotic or eerily quiet hospital at all hours of the day and night. I found myself pouring over my handheld Pocket Medicine book, the Epocrates application on my phone, and UpToDate online trying to figure out why my patient didn’t match the textbooks. Frequently at 5 a.m., you could find me debating with myself about whether replacing the low potassium on my patient was best achieved with an oral pill or intravenous medication and at what dose, finally deciding on which one to choose, only to have the nurse respond kindly, “well, I can’t give that high of a dose by the peripheral IV and don’t forget even the lower dose is going to burn like hell.” I was back to square one, only now it was some 10 minutes later, which meant yet another day I wouldn’t have time to use the restroom before the official start of the very long workday.

Then there were the times when we thanked our lucky stars that the night shift was over, and we could at least sit down at the morning conference, only to get picked randomly to present my case to all the residents and explain the pathophysiology of a condition I unfortunately hadn’t even considered yet. If only there had been time between the 3 code-blues to read about all the things the attending was now asking me about. If only the hospital computers allowed Google, or better yet, if ChatGPT had existed back then.

During those physically and emotionally exhausting times it would have been easier to not wonder why my patient was extra grumpy that morning, why that man kept calling me a nurse when I had clearly introduced myself as a doctor, or if that one patient who never had any visitors felt lonely and maybe just needed to talk. Not always, but many times we took a chance and waded into those murky waters willingly and felt all the more fulfilled at treating patients whose humanity we took a few more moments to connect with. When we engaged with patients beyond asking the necessary medical questions it was almost as if beyond the doctoring duty, we were taking the time to truly visit with the sick, engaging in Bikur Cholim of sorts. Those are the patients I remember the most. Like the special lady in the end stages of metastatic cancer who spent more than a month in the hospital. One sunny afternoon, about a week after I had finished my rotation on the wards, I went back up to her room just to say hello. She had made an impression not only on me but on several of my colleagues, for I found myself among 2 other residents all of whom had interrupted their busy day to sit at the foot of her bed for a few minutes talking about the meaning of life with someone who was straddling the divide between this world and the next.

In the hospital, patients have dozens of (mostly unwanted) visitors every day, consisting of nurses, students, doctors, social workers, physical therapists etc. The lucky ones have family and friends to hold their hands, to bring yummy snacks, or advocate on their behalf. Many times, those quietly nursing an illness at home are the most isolated and in need of Bikur Cholim.  In Genesis, we find the first instance of Bikur Cholim in the Torah; Abraham circumcises himself and a few days later while in considerable pain, rushes out to greet 3 men who have appeared by his tent. The Midrash explains they are angels, each sent by God with a specific mission; one angel to heal Abraham, one to announce his future son’s birth, and one to warn Abraham about the impending destruction of the city of Sodom. God models the mitzvah of visiting the sick for us in this story and we are encouraged to emulate God by doing the same. Evidence suggests that hospital visitation positively influences patient recovery, reduces stress, and provides emotional support.  Yet sometimes, the nature of the illness itself doesn’t lend itself to visitation, like the exquisite loneliness in the recent pandemic, or as I myself experienced some fifteen years ago.

After my first year of college and the overwhelming choices available of what to study, I decided to spend the summer at my grandmother’s house in Arequipa, Peru and volunteer in the pediatric department of a local hospital to see if I would pursue a medical career. My parents had both studied medicine in Peru and knew that even as a lowly college student I would be allowed to participate in patient care in ways I couldn’t even dream of in the United States. On my last day in Peru, after having been meticulous about eating very specific home cooked meals and being somewhat obsessive with my hand hygiene and glove use, I fell ill. I had spent the last month excitedly learning to start IV’s on little arms smaller than the palm of my hand. But I had also been rounding with medical students and doctors in an exceedingly depressing pediatric ward where one 3-year-old boy was dying of liver failure and had been abandoned by his family. My fever began during my flight home and no amount of ibuprofen was able to bring it down. Soon after landing, my appetite disappeared, and the nausea and vomiting began. A few days later I started turning yellow, my eyes, my tongue, my skin all turned me into a human version of the Simpsons.

With both parents being doctors they already knew my liver enzymes would be high, though not in the hundreds like they were. The at home blood tests explained my diagnosis; acute Hepatitis A attacking my liver. I was instructed to self-isolate especially from my brothers, no one was allowed in my room and especially not my bathroom. The only things I ate, soup and Jello, were left at my door. My parents cheated though; they were sure they had had hepatitis A long ago, probably also acquired in Peru, and were now immune so they broke quarantine many times. Thank God.

Even so, I remember how lonely that month felt. I saw nobody outside of my home and I can’t even remember if any friends called me, though to be honest I don’t think I have told them the full story to this day. The isolation left me with a lot of time for reflection. I had acutely felt the effects of liver damage and decided I would cherish my liver and never drink to excess in my life. I became thankful for the feeling of hunger when it returned, and I was thankful when I was able to eat the first full meal of solid food after a few weeks. During that time I would have welcomed anyone who had tried to fulfill the mitzvah of Bikur Cholim even through a mere note or phone call. Thank God I was eventually told by the gastroenterologist that I was no longer contagious and was fully cured with lifelong immunity to Hepatitis A. When my friends called and I got to see them after my quarantine finished, the weight finally lifted.

It has now been a bit more than a decade since my medical school graduation and I know I need to work harder at Bikur Cholim. The impersonal, disconnected and somewhat sterile demeanor is sometimes the only way doctors make it through our day. We get burnt out and emotionally exhausted wading through the pain, the disappointment, the fear, that so many people experience when facing debilitating health crises. But please know that sometimes right after seeing you, your doctors cry too. Sometimes late at night when they can’t sleep, they remember you and sit in wonder at your extraordinary resilience and bravery. We pray that one day when we fall ill, there will be someone there to hold our hand and our heart too.