Reflection on the Health Care Ethics Internship
The Health Care Ethics Internship at the Markkula Center for Applied Ethics is a yearlong program that places students in hospitals and other health facilities. During their clinical rotations, student interns learn about day-to-day ethical issues and dilemmas from nurses, physicians, and other health care professionals. Here, Elizabeth "Liz" Connelly shares what she learned from her two years with the Health Care Ethics Internship Program at the Markkula Center for Applied Ethics--first as a Health Care Ethics Intern in the 2013-14 class, and then as the 2014-15 Honzel Fellow in Health Care Ethics.
When I tell people I want to be a physician, they often ask when I knew it was the career for me. I am always at a loss to answer. I have no recollection of the moment when I made this decision. I know that I was inspired by my high school biology teacher; I know that my personal experience with illness prompted me to tend to others, and I know that even as a child I was fascinated by healing and medicine. However, looking back, I am unable pinpoint the exact moment this dream came into my life.
It is interesting to me that the origin of my goal continued to elude while my reasons for pursuing this path were clear. I wanted to save people. More so, I wanted to understand the mechanism of illness and then reverse it. I saw disease as the ultimate foe; one that I planned on defeating. My two years with the Health Care Ethics Internship Program at the Markkula Center for Applied Ethics have eroded this finite understanding of purpose. By pushing me to understand medicine as more than a series of symptoms and treatments, this internship has opened my eyes to the humanity behind the medicine. My shadowing experience taught me how the feelings and values of a patient and physician interplay, and how a "right" way to treat a patient is often unclear. It highlighted how human emotions are not extraneous barriers to providing accurate and quality care. Instead, they are equal partners in the creation of the patient's situation and therefore should be equally important in caring for patients.
This new non-dichotomous way of thinking was most challenging when I encountered issues of care at the end of life. While shadowing in Intensive Care Units, I was awed by the ability of physicians and nurses to sustain life artificially for weeks or even years. However as I learned about these patients, I realized that many existed in a strange medically sustained place between life and death. The circumstances facing one patient were particularly striking. An 80-year-old man was being seen in the ICU with severe Parkinson's and dementia. His organ systems were slowly shutting down, and he was connected to a ventilator to help him breathe. He could not talk or communicate, and according to his doctors would never regain any level of significant functioning.
Yet he was still "alive." As I watched this patient's progress and heard his family's struggle, I felt that the nobility of medicine, which I used to champion, had faded and was instead sheltering us and the patient's family from a tragic, yet imminent loss.
I cannot speak personally of the difficulty of such a situation because I have fortunately not been faced with such a decision. I also do not want, in any way, to undermine the tireless effort of the doctors and nurses who fight to keep these patients alive. Yet as I observed this particular patient, I began to wonder if my previous goal, to "triumph over the evil of illness," was truly compassionate or even appropriate in all cases. The technology we have to keep patients alive is incredible. We can support their breathing with a ventilator which pumps oxygen into their lungs. We can dilate their veins and arteries to help with blood flow, provide IV fluids and even long term nutrition. But these interventions, while incredible, do not truly mend the pain being felt by both the patient and his family and friends.
My struggle over the issues of end-of-life care became clearer after shadowing nurses, social workers, and physicians who specialize in hospice and palliative care. Through my time with these groups, I saw that often the greatest service given in times of immense hardship is comfort and compassionate care. The patients I visited during these two rotations were surrounded by care, love and support, rather than machines and physicians. Instead of always fighting against the disease, these providers walk with the patient through it. They were not neglecting the medical solutions; they were simply viewing the person as more than a series of parts to be maintained, and instead a person or spirit to be valued and ensured dignity.
As I pursue a future in medicine I still plan on fighting tirelessly against illness. I plan on giving my patients every opportunity and advantage that could help them succeed in their fight. However, I also want to recognize when my fight needs to stop. I do not want to just treat patients, I want to be a physician who stands beside them, understands them, respects their values, desires and dignity in all things.
I do not know when I decided I wanted to become a doctor. However, I do remember when I decided what kind of doctor I wanted to be, and I credit this internship fully in helping me make that decision.