I Was a Homesick, Grieving Medical Student. The Arts Helped Me Heal.

Nathan Douthit, MD

I attended medical school overseas. My wife and I had been married for one year; we were both interested in missionary work and went together to Israel. We enjoyed our time, but the initial loneliness was crushing. The rigors of medical training felt overwhelming and hobbies began to fall by the wayside. We then experienced the miscarriage of our first child. In the next 12 months, we lost two more pregnancies.

As I was grieving, I connected with a few other kindred spirits: classmates who, like me, loved medicine but struggled when totally immersed in scientific knowledge and biomechanical thought processes. We were longing to see the beauty in our work. 

We began meeting together to read books we selected  for each other. We read fiction and non-fiction, prose and poetry, history and sci-fi, graphic novels and plays. Each selected according to their interests, and exposed others to new narratives, modes of communication and forms of art. I learned as much from this group as I did in any medical school course. This group revealed my biases, my misconceptions, and my needs. It became a source of life for me.

“As we seek “health” in the bodies of patients, we contribute to the deaths of our souls.”

While my story is unique, its themes are common for those in medicine. Medical training causes removal. It may be relocation to a different city, or simply required absence from community, religious or family events. The time requirement to succeed in medicine slowly strips away everything else. We are left alone in a field that always demands more of us. With this vulnerability, we are routinely exposed to the worst aspects of our society conspiring against patients to create illness. Politics, bigotry, and greed result in the most marginalized in our culture becoming unwell. In the face of these insurmountable forces, we try to keep up with the ever growing base of medical knowledge while fighting off a gnawing inadequacy exacerbated by bad outcomes, insomnia, as well as abusive patients and colleagues. We are constantly fighting death, but always eventually surrendering.

In this setting, burnout, detachment and apathy become common. We sacrifice our own capacity to feel. Patients are viewed as inconveniences at best—at worst they are enemies. It can seem that despite our efforts to help, the patients seek only our hurt. Wounded as we are, we depersonalize our patients. They become “great cases,” or “teaching opportunities,” or “gomers.” We make them textbooks, machines, or even subhuman creatures. We are students, mechanics, or veterinarians, trying to protect ourselves from the trauma of the work we must do. We retreat from the bedside to advance our careers. As we seek “health” in the bodies of patients, we contribute to the deaths of our souls.

No work captures this phenomenon quite like “House of God.” While the book is not without problems, the emotional progression of Roy Basch, the intern protagonist, is experienced by many. Throughout his first year, he feels disgust, rage, apathy, and finally, once he has succeeded in smothering his humanity, acceptance. He loves to be in the hospital, and seeks to transform himself into a machine. His first night off he spends back in the intensive care unit, until rescued by his partner, Berry, and forced to expose himself to beauty in the form of a mime exhibition by Marcel Marceau. This involvement in his community, appreciating art and beauty, has a powerful effect.

“All of a sudden I felt as if a hearing aid for all my senses had been turned on. I was flooded with feeling. I roared. And along with this burst of feeling came a plunging, a desperate clawing plunge down an acrid chasm toward despair. What the hell had happened to me? Something in me had died….

Later, Berry welcomed me back to her, and I felt her caring arms around me as if for the first time. Awakening, I began to thaw. I began to feel a trickle, then a rush of feeling that was scary and overwhelming. Choked up, I began to talk.”

Art can shield us from the assault of medical training. The appreciation of beauty can teach us how to feel. Involvement in community helps us connect again on a human level. The artist shows us how things are and hopes with us for how they could be. Artists can display lived experiences of illness, social structures and systemic violence to increase our empathy. By appreciating the suffering of our patients as humans, we recognize that the lab values or imaging findings don’t describe the person bearing this burden.

“There is beauty outside of pathophysiology, marvels outside of drug innovation, rebirth and renewal outside of resuscitation.”

I learned this necessary lesson as a homesick, grieving medical student. But as I moved from medical school to residency, I again lost touch with this routine exposure to beauty. I was able to survive, but as my training progressed, so did my fatigue. In my final year of residency, I discovered the MedHumChat community on Twitter. MedHumChat was a virtual version of my medical school reading group. It forced me to make time to expose myself to art and beauty, and to remind myself of the love I felt for my work. In many ways, I did not realize the extent of my apathy until I again saw passion.

To deliver medical care is to be aware of brokenness, be it society’s, the patient’s, or our own. An intentional pause to appreciate beauty, to discuss humanity, and to explore our own emotions can be a healthy defense to repeated traumas, the constant strain that pushes us to our demise. There is beauty outside of pathophysiology, marvels outside of drug innovation, rebirth and renewal outside of resuscitation. Modern medical care drives us to continually hone the technical aspects of our craft. To be a good clinician, one must first be a good person. This means that we cannot only devote ourselves to medicine, but also to the humanities. Anthropology, literature, visual arts, theology and history all ultimately help us to study ourselves. This leads to our own renewal. We neglect art, beauty and community at our own peril. These bring us to life, even when we don’t expect it.

Nathan Douthit, MD (@ndouthit) is a chief medical resident at a community-based internal medicine residency program in Birmingham, Alabama. He is interested in medical education, medical humanities, and health disparities. He has needed reading and writing to help him survive the training and practice of medicine. He has been involved in Medical Humanities Chat since its inception in January 2019. His free time is wonderfully occupied with his wife of 8 years and their four sons, all of whom keep his soul alive.