Tending and Witnessing
A vision of ourselves and our healers beyond cost-effectiveness and efficiency
I sat there stunned.
Vision blurred.
Was the car smoking? The airbag felt hot, so my brain leapt to, “is the car on fire?
I quickly grabbed my bag and sprang from the car. A passerby found my glasses shattered in three pieces 20 feet away from the car.
My neck was already throbbing, with a strange electrical sensation over my skin, but one of the perks of being an ER doctor is that I could examine my own neck to make sure it wasn’t broken. (Admittedly, there probably is no evidence to back up that practice.)
Shortly after the accident, I thought the moral of this story was actually about asking for help because I called in for work the next day. This is progress for me, but it’s not that much of a revelation, because no one really wants a shaken-up, semi-mobile, bag of impressively bruised flesh to be their doctor when the alternative is a fully functional human being. It turns out the help that I needed—that most of us need when we are suffering—was not a type of help I even knew how to identify, much less ask for.
Once, I knew there wasn’t a physical injury to the bones in my neck, there wasn’t really any reason to go to the hospital. In the current state of healthcare, the reason you go to the hospital is to see if there are any broken parts of you that are fixable. If there is not something that can be visualized or quantified and something that can be fixed (like a broken bone or a heart attack), then you will probably find your interaction with the medical system feels rather frustrating and pointless.
I knew after my not-so-sophisticated exam standing next to my smashed car that I did not meet those criteria. I didn’t realize until months later that I longed for someone to tend to me, to hold me or hold my hand, to listen to the story about the big, scary thing that had happened. I yearned for someone to rub oil on sore muscles. I wished for someone to show genuine care. Real attention and care is so healing. There’s little more powerful than knowing that someone is concerned about the state you are in, good or bad. (Especially bad.)
I wonder how many times people seek healthcare more for this tending and witnessing than the more quantifiable results. I wonder how often they are disappointed when they do not receive that, when they are caught up in healthcare’s need for efficiency.
I walk into the room. I ask enough questions to figure out what tests I need to order and what treatments I need to administer. If it’s not too busy, I might add a couple more questions for the sake of human decency, but that’s about all of the tending and witnessing you are going to get from me, at least in this system.
Unusually, I don’t really feel guilty about that. I simply do not have the time or the emotional capacity to provide more in the current system. Maybe doctors aren’t meant to be the ones providing that kind of care. Honestly, I don’t know. The type of attention I needed could have been provided by any compassionate lay person if I had known to ask.
On the other hand, I think reasonable people would agree that a doctor is supposed to be a healer. In my job as a healer, I don’t have the physical or emotional capacity to tend and witness the suffering of others. To me, that seems profoundly problematic.
We are our brothers’ keepers, but many of us have structured our lives so that we are simply too busy to tend to each other. Because of that, we have off-loaded that function to the healthcare and elder care systems. Then, people who are similarly busy and overwhelmed are charged with tending to people who aren’t their own. To be frank, we do a shitty job with it.
A big part of the problem is our society’s view that efficiency and cost-effectiveness are the ultimate social goods. What a bleak view of the wonder of our world. What a diminishment of the complex richness of the human experience and the profundity of human emotional needs!
What percentage of people feel overwhelmed most of the time? I would guess a majority of American adults do. In fact, 48% of Americans my age (35-44) feel completely overwhelmed by stress most days. Younger Americans feel even more overwhelmed. For myself, I will give a conservative estimate and say that I am overwhelmed at work about 60 to 70 percent of the time. As a result, I have consciously created a low-key life outside of work to minimize that feeling in my life overall. When I’m overwhelmed, I can only do the essentials. I focus on only “moving the meat” to use the crass, cynical vernacular of burned out ER doctors.
Humans evolved to need so much from each other. Yet we’re so overwhelmed that we don’t know what we need, can’t see what others need, and don’t have the energy to help even if we do identify others in need.
It all feels so backwards, and it feels like it’s only getting worse. Doctors are becoming so burned out that there are now national level interventions to address this. However, the solutions that hospital administrators are proposing are AI-based patient communication and documentation. Doctors have come to be thought of as cogs in a machine rather than human beings.
We need time and care, just as all people do.
We need to be tended to and witnessed.
Once this has happened, perhaps someday, we will have the energy to tend and witness others. It’s only through this genuine care and connection that the soul of healthcare, indeed the souls of our communities can be saved.
"If there is not something that can be visualized or quantified and something that can be fixed (like a broken bone or a heart attack), then you will probably find your interaction with the medical system feels rather frustrating and pointless."
This. This right here is something you learn at lightning speed when you have a chronic illness. The US medical system is so broken and I feel bad for the doctors and nurses trying to work within it. My primary doctor is amazing. He is passionate about healing people, but he is not given the ability to slow down and really help.
This reminds me of the poor medical care my wife received from a doctor. I looked him and and left a review on every page I could fine. Our doctors should be healers but they are often not. I wish they was some kind of metric scale for tenderness. Bed side manner is so key when working with people - especially when they, not just their bones, needed tending too.