“Entertainment, shock, distance”.
As on Jeopardy -- What question is being answered?
A clue – the physician with whom I worked most closely during the nine years before coming to Barnes-Jewish recalls vividly an experience as a 1st-year resident on an ER rotation.
I round a hallway corner in the ER and find myself standing suddenly face to face with a physically imposing patient sitting on a gurney to which his wrists and ankles are chained. His steely glare does not arrest me. It is the bullet hole between his eyes. I learned later the bullet had hit him at an angle that allowed it to track along his skull under the skin to the back of his head.
Another clue – the physician* who created my first opportunities more than 25 years ago to shift from being a history professor to being an ethics educator in the medical education/practice sphere recalled vividly an experience as a 3rd-year medical student on a Psychiatry rotation.
Tremendously thick glasses . . . barely five feet tall . . . obese . . . protruding front teeth . . . long matted hair . . . only blue swim trunks . . . -- this ER patient is shouting aimlessly, “Thou hast not known me, but thou mayest yet know I am the Christ!” He holds up his transistor radio and claims, “I have direct access to God”. I join my fellow medical students, the residents, and the nurses in chuckling about this character who is too comical to disturb us. It all seemed funny then.
48 hours later, I see him again -- sitting in a padded cubicle . . . banging his head against the wall . . . rolling his eyes . . . clawing at his face . . . jamming his fingers down his throat. When he sees me through a small window, he charges toward the door . . . his face twists with pain . . . his eyes glare at me . . . he screams profanities . . . he tries in vain to attack me. I now realize how quickly/easily my health could slip into his illness, my ‘normal’ could slip into his ‘abnormal’. I feel weak . . . nauseous . . . overpowered.
The question being answered -- “Why do we tell ‘You would not believe what I saw/heard’ stories?” (Yes, I know there are more colorful names for this story type!)
I have asked this question many times -- in private conversations with medical students . . . in didactic sessions with residents . . . in staff meetings with nurses and other medical team members . . . during national meeting presentations for medical educators. The answers I receive are without exception variations on “entertainment” or “shock” or “distance”.
How do we tell these stories? How do we view/present the patients when we tell these stories? Where do we tell these stories? to whom?
Think about it. Perhaps talk to a coworker.
*After finishing his commitment to the Navy, Tom Elkins (1949-98) began his academic career with the
