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What I Know About John Doe: Humanism in Medicine

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I was well into my intern year of Internal Medicine when my residency program sponsored an essay contest with the prompt: “Humanism in Medicine: What This Means to Me.” By this time, I had been through the proverbial ringer. Adjusting to this new career was difficult. Working in a large inner-city safety net hospital, I spent every day facing the cruel inequities of our society, wanting better for my patients, but feeling powerless. I had witnessed the mercilessness of homelessness, poverty, and substance abuse. I had felt the frustration of the revolving door and lack of resources. At some point, I began to feel a numbness – slowly encroaching, contemptible but calming. I had become blind to the beautiful moments, apathetic to the small victories. Parts of me had surrendered. I had lost touch with my humanism.What’s worse, I was watching it happen and did not know how to stop it. When this essay contest was introduced, I knew it was my chance to reflect and refocus. So I sat down to write:

My understanding of Humanism in medicine was not taught to me in medical school. It was not on Step 1, 2, or 3. It did not come from a lecture, a practice question, or rotation. Its meaning is not static. It changes and evolves as I do. It is a value – a purpose. It is the tenet that for no profit or reward, no logical reason at all, this life I hold in my hands is intrinsically important. This patient is a person, and this person trusts in me, the physician, in his most vulnerable moments. Humanism is to cultivate a practice founded on these truths, for no other reason than to do right by another person.

When I was a medical student in New Orleans, I inherited my first patient with no name, found down an alley in the French Quarter behind a bar where I used to work. He had no ID, no phone, and there were no witnesses. He was intubated, resuscitated, and survived. Due to the prolonged cardiac arrest, however, he also sustained significant brain damage. Five weeks into his hospital stay with no improvement, there were decisions to make. We needed a next of kin. Without a name, we had no one to speak for him and no way to find them. He had to have a name. I called police, hospitals, homeless shelters, churches, missing persons. I went to the alley where he was found to see if maybe he had dropped something there. I asked the bar-back who found him if he had ever seen him before. I called the Emergency Medical Services company to be sure he didn’t have any belongings that might have been left behind in the ambulance. Eventually, I ran out of time. The court system appointed him a legal guardian and the decision was made to withdraw care. 

I had never met this person. He did not know me, or know that I was even there. He did not know about the hours I spent trying to find his name. He didn’t know how frantically I searched – who was this person who somehow lost his name? How could this happen? Here was this man, my patient, born on some day in history, who had a mother, went to school, had friends, maybe had kids or a spouse, was a child himself at one time. What if there was a person, or several, who would spend their lives wondering what had happened to their friend, brother, father, etc.? What if they were wondering if he suffered, if he was scared or alone? What if they were hoping he would find his way home?

I never heard the sound of my patient’s voice nor he mine. But I knew the sound of his heartbeat, the scar on his left knee, what his kidneys were doing that day. I knew the antibodies in his blood, the way his heart threw extra beats when he was being turned, the size of his liver, the volume, in mL, of each breath that he took. Mostly, I knew he was alone. I knew he was dying. Moments from the end of his life, I still did not know his name. 

Someone, I thought, should see him through. Someone should carry some sadness for him. Something should be different because this person who was alive was leaving forever. Someone should be changed because he was in the world. This person was not just some body and he was important, if only to me. 

He was extubated on a non-descript afternoon. It was uneventful and everyone went about their day. The nurse watched his telemetry from the charting station nearby. My team signed out and went home. I stayed at my patient’s bedside and held his hand. I watched his chest rise and fall. It was rhythmic and deep for minutes or hours. His breaths got slower and smaller until finally he was still. 

Humanism, to me, is to allow our patients, our practice, to change us. These divinely human moments are not meant to be met with indifference. As physicians, we bear witness to suffering, we seek to comfort, we endeavor to heal. When medicine has reached its limits and there is no cure, no more tests or treatments, all that remains is one human being sharing this moment with another. Humanism is the reason for medicine. In medicine, I found my purpose.

Elyse is an Internal Medicine resident at Grady Hospital in Atlanta, Georgia. Originally an artist, she fell in love with medicine while working in public health in Mozambique. She graduated from Tulane School of Medicine and plans to return to New Orleans to pursue a career in primary care and community outreach.

Image by Monstar Studio / Shutterstock

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