|Artist & Gallery|
There was social comment: the ability to deal with the frustrations of patient care during the residency had not been addressed. And ideally the figures in the art work should be faceless just as in medical school when the young students are taught that the patient's color, creed, beauty, social position or economic status does not jeopardize the physician's care of him. Here again, it seems to be otherwise. Besides nurturing people who have never been nurtured very much before, what does it do to the doctor to treat a patient less well than he knows the patient needs to be treated...not to be able to do his best.
In addition to doctor/patient relationships, feelings of death and illness, poverty and chance and the uncertainty of medicine permeated the work load. These subjects are still anxiety provoking in that they are suppressed in our society for both the doctor and the patient. This hospital training touched on a lot of taboo subjects and resonated powerful emotions.
In a sense I was a symbolic resident. As I identified with the medical house staff I went through all the stages of growth toward empathy as they did. I saw myself in both the patients and their doctors. I, as the beginning residents, first felt enthusiasm, high hopes, missionary zeal and somewhat unreal expectations. There was a tendency to over-identify with the patients and feel that anything was possible with enough application of time. Soon after, I, like they, began to wonder if all the effort was really worthwhile. I realized that they saw patients returning after being dismissed. They felt lonely and abandoned, burdened by bureaucracy and a sense of powerlessness. Their lull in growth created doubts in the value of their work; too many complicated cases, continually relapsing or too disturbing caused problems. They slowed down.
My art work, which stood for the re-emergence of empathy in their work, did likewise for many months. Also working conditions, long shifts of duty, insufficient salary for their work or wondering if programs at other hospitals are better became questions for them. It was the "system", they felt. They became angry. There were committee meetings and at some County Hospitals strikes and fights with the County Commissioners about how money was budgeted. For example, a community spent $20 million on sports while a requested $7 million for patient care was denied. The community resists change and the doctors respond by becoming disillusioned. As one senior resident recalled his experience at the County, "I felt like a spurned lover. I gave out so much and got back so little. I wanted to aid the less fortunate; I felt I had so much to give, but I was frustrated by the institution which does not respond no matter how much fidelity I have to it. It was a one-sided love affair. You have many Dr. Jones' at County looking for stroking and can't get it. I realized that one can only get it from real-live, mature relationships, from people not institutions. Perhaps not everyone can have straight teeth and good bowel movements or not stomach pains." It seems that there was denial, anger, resignation or indifference before there was a re-emergence of compassion, which is innate and usually happens if one comes from a healthy background and spawns a more effective philosophy about one's role as a physician.
Solutions: Some recognize that physicians can only be responsible for their own tenure with a patient, not before he comes or after he leaves. They did not cause the patient to be fat or diabetic. The long preliminary life behaviors that caused pathology were not their fault. Social conditions that stand in the way of achieving and maintaining good health are not within their control. The doctors begin to realize that they absorb the anger of the patients toward society...most of the alcoholics and drug abusers and other who have not taken care of their bodies have been angry and have turned in feelings upon themselves. The doctors in the healing process absorb some of the causes of the patient's anger, society's rejection, in their care of the patient. But doctors likewise fill up with that anger, turn it in upon themselves and become depressed. After a while, the young doctors come to understand that they must develop professional detachment and view the patients with kindness, but from a vantage point, other than sociologically, to be able to survive. The patients do provide a wealth of clinical material for them to study the natural course of a disease at every stage. He can stay on at the County Hospital and be a facilitator or leave for a more sensitive hospital experience. He must also try to enrich his own social life so as to balance his professional work of constantly giving out. If he gets too caught up with the personal needs of his patients, he can no longer function as a doctor. So he trades off: he gives out care and treatment to the patients, and in return he will take in, at times, knowledge and gratitude.
Excerpt & image from: Lesser, May H. The Art of Caring.