When the Pain Stops Hurting: Reflections of a Medical Student

My phone buzzed, and I looked up from UWorld.

"Next case will start in 5 minutes. You really don't need to come to this case if you're uncomfortable..."

Growing up in a conservative community, I had indicated to my clerkship directors that I might want to sit out cases like this one.

"No, I think I want to be there," I replied. "On my way."

Patients on UWorld are not like real-world patients. All they get is an age and a gender. Real patients have names. Personalities. Sometimes families. Smiles, laughter, confusion, frowns.

The patient in Pre-Op 104 was in tears.

"Do you know what you're here for?" the resident asked the expectant mother, as part of the routine preoperative checklist.

She didn't answer with words, but the way she covered her face with her hands said enough.

The decision to come here was not one anyone had taken lightly.

The notes explained why. The amniotic genetic screening had revealed a devastating diagnosis: a rare genetic disease, a shortened life expectancy, and a future filled with procedures simply to stay alive.

Months earlier, as an M2, I shadowed a pediatric neurosurgeon and met some of the sickest children in the state. Children whose lives were dictated by seizures, medications, surgeries, and emergency room visits. And parents who knew of little else.

One of the first patients I met with a severe genetic disorder arrived in a wheelchair. She could not speak. Her mother showed little emotion.

I asked the neurosurgeon why parents of children involved in traumatic accidents often seemed more visibly distressed than those caring for children with chronic, life-limiting illnesses.

She paused.

"They've already mourned," she said. "Now it's just maintenance."

"Are you okay?" the OB-GYN asked as I held out my hands for my sterile gloves.

"You seem very uncomfortable. You really can leave at any time"

"No, I'm fine," I lied.

It was the same lie I had told a few months earlier after witnessing the death of a child for the first time.

He arrived in the ER from a nearby group home for disabled children with an EMS and his caregiver nurse. I was doing CPR on the child when his parents had arrived and walked into the trauma bay.

The child’s parents were shocked. But there were no tears. They had already mourned.

I glanced at Mom's face as the CRNA administered the sedation. The tears that had filled her eyes moments earlier seemed frozen in place as she drifted off to sleep.

My own tears finally came out.

The worst pain is the pain that stops hurting.

And I hoped that Mom would never have to know that pain.