John Shumann, MD Keynote Address
Excerpts from GHHS Keynote Address Fumbling Toward Wisdom
John Schumann, MD, Assistant Professor of Medicine
By John Schumann, MD; Assistant Professor of Medicine, Section of General Internal Medicine
Ten years ago I was a wet behind the ears intern. My first night on call, I “capped,” meaning I hit the ceiling of patients I was legally allowed to admit. An inauspicious beginning.
Too few nights later, on the next call day, we admitted Ms. D, a septuagenarian in the throes of dementia. She wasn’t able to tell me anything about why she’d come to the hospital. She’d been brought by her family, who were concerned that she had stopped eating, and was throwing up what little she ate. The surgical resident intimated that an operation on such a debilitated elder would be futile. The attending physician sprang to action informing the family of the hopelessness of the situation. The family agreed that an operation wouldn’t fix things, and would be cruel to their dying matriarch. The patient was dead by nightfall. The next day, disinhibited for want of sleep, I sat at rounds and felt as though I had killed Ms. D. Without knowledge of palliative care; lacking experience in pain management; unschooled in the doctrine of double effect, I felt steamrolled by my aggressive attending, whose bidding I’d feebly carried out for lack of gumption in challenging her authority. As my tears made clear to her, interns are often ill-equipped to deal with emotion-laden issues like suffering and death. To her credit, she let us use teaching rounds that morning to discuss the emotional aspects of caring for the sick and the dying — giving space to me and my teammates to process and vent these overwhelming feelings.
I remember feeling better that I’d been able to express my concerns, and share the emotions. But doubt lingered: “Would I really become inured to suffering and death? Would that necessarily be a good thing?” Obviously, it would help to get through the long nights and days. But wouldn’t a part of my humanity be dampened or lost?
By spring, I’d survived enough of the internship to know the end was in sight. Lois, a grandmother, had reached the end of the line with regard to her lung cancer. In one of my proudest moments of internship, I entered her room with more than a dozen of her family members huddled on her windowsill and at the foot of her bed. Realizing that all of them were terrified of seeing their loved one dying, it occurred to me that showing them they could touch her might ease everyone’s pain. I went up to Lois, and put a cold cloth on her forehead, gently stroking her hair out of the way. “You can touch her,” I said, “She knows you’re here and wants your love.” A month or so later, her daughters wrote me a letter telling me how much my gesture had meant to them.
Only a few months before, during orientation for that internship year, my Chairman proffered wisdom that helped me in difficult times, and has stayed with me since:
“There will be many struggles,” he said, “but do not get bogged down in the mundane details — the blood draw, the medical procedure, the cancelled test. Instead, struggle with the ethical issues, the patient’s core values, the challenging decisions — those where there is no clear path.”
I used Dr. Bor’s high-minded advice when I was an intern, remembering not to waste too much energy struggling over those missed blood draws on my patients. I used it as a resident to counsel new interns. I remember it now as an attending when I work with students and residents.
I want very much for Gold Humanism Honorees to share all these bits of wisdom. May your struggles be meaningful on your own paths to wisdom.
