Next Generation is a Brigham Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. If you are a Brigham trainee interested in contributing a column, please email firstname.lastname@example.org.
This month’s column is written by Crystal J. J. Yeo, MD, PhD, MRCP (U.K.), a Neuromuscular Medicine fellow in the Department of Neurology.
My first memory of a steely purpose to become a physician was at the age of four, sitting on the shoulders of an uncle, looking upon the peaceful face of my aunt, only in her 40s, who had passed away unexpectedly from a heart attack. We were close.
The priest, attempting a moment of levity, patted me on the head and said to my family, “Look, there’s a future doctor.” I looked at him and thought: You provide healing at death and I will provide healing in life.
Fast forward many years to when I became a student leader at the University of Cambridge in England, representing my cohort of MD/PhD students. I was energetic and full of drive to save the world with science and medicine. Gradually, I found deeper meaning in the strong and complex connections with my patients and their families.
Compassion and Healing
The first patient I diagnosed with amyotrophic lateral sclerosis (ALS) struggled to accept her diagnosis and turned up suddenly at the emergency department two months later with wasted muscles, gasping for breath, wild-eyed with desperation. Her family was devastated at her suffering—as was I. I hurried down to the emergency department when I heard the news but could not find comforting words then. They were grateful for my silent presence.
Just a few months later, she requested that I arrange for her terminal extubation and autopsy. I wept together with the family as she passed.
This is just one example of the many patients whom I’ve cared for and suffered with. Another experience that comes to mind is when I saw a pious patient with bulbar ALS lose her voice but not her courage or faith.
I saw frontotemporal dementia and ALS manifest in a young mother with a genetic mutation. Her young children could not understand the change in their previously dedicated and caring mother, nor the time-bomb which they might carry in their inheritance.
With every patient, I realized that healing is more than about saving lives. My focus became compassion: understanding every patient and assuaging individual needs for dignity and comfort.
Many neuromuscular patients have chronic and serious diseases, which leave a terrible toll on them and their caregivers. Some diseases have no treatment options. In others, treatment costs outweigh the benefits. Have I the moral authority to comfort my patients and say, as per John Donne, “Death be not proud,” for “one short sleep past, we wake eternally, and death shall be no more?” Since all life is terminal, perhaps healing needs to occur not just in life but also preceding death and at death.
Compassion and Resilience
Throughout my career, I’ve learned that healers are also fueled by compassion. While serving on regional and national neurology committees as a neurology resident, I heard about the physician burnout epidemic. I felt enormous sympathy for colleagues who, like our patients, were only human and deserved the same compassion.
My concern on how burnout affects the ability of physicians to care for patients, especially those whose families need compassionate support, led me to work on this issue. I initiated wellness programs to identify at-risk trainees and provide smartphone mindfulness interventions to trainees to improve their physical and mental wellbeing.
In 2017, as Hurricane Harvey hit the Texas Medical Center and left a trail of devastation in its wake, I helped to rebuild houses for those whose lives were wrecked by the flood.
Working on the hypothesis that altruism and compassion protects against physician burnout, I studied first-year trainees who volunteered to assist those in need during this natural disaster. Despite having limited resources of their own, those trainees who volunteered their time and money to help others turned out to have higher self-esteem and resilience. They felt appreciated and experienced less burnout.
Integrity and confidentiality are essential in this line of advocacy. At the American Academy of Neurology (AAN) Palatucci Advocacy Leadership Forum in May 2018, I received training on effectively advocating for physician wellness through collaborating with mass media and legislators. The AAN funds me to provide an easily accessible online resource with practical advice for physician wellness advocates wishing to take their advocacy to higher levels.
Compassion and Humanity
When I look back on my journey, compassion for patients, family and colleagues has been the common thread which sustains and informs my work in neurology and neuromuscular medicine. To understand my patients’ stories is to understand what it means to be human. My research suggests that compassion and resilience go hand in hand.
A little kindness and compassion make it possible not only to exist, but to thrive. My hope is that cultivating resilience, compassion, gratitude and integrity among ourselves and each other promotes life-skills that help us to flourish in life.
In the words of the poet Maya Angelou, let us be “a rainbow in someone else’s cloud.” The healing power of resilience and compassion cannot be underestimated.