“Everyone you meet is fighting a battle you know nothing about. Be kind. Always” -Robin Williams
In my first week of Medical Assistant training school, three concepts were drilled into our heads. They continued to be imperatives throughout the entire academic year, and are expected to be applied in an actual working environment.
The first two are related, and immensely important in stopping the spread of illness. Healthcare facilities are hotbeds of disease, naturally, so these commandments must always be followed. The first two are: medical asepsis and the Standard Precautions. Medical asepsis (a: against, sepsis: the presence of dangerous microorganisms) means keeping your work environment as clean as possible, as well as yourself. These tie in with the CDC’s Standard Precautions: hand hygiene, the use of PPE, sharps safety, sterile instruments and devices, and more.
A brief note on washing your hands: this is the single best invention of healthcare, and one of the most crucial. Here, in the Covid Age, it is vital.
The third concept that is hammered into a Medical Assistant student’s head is more abstract, and extremely crucial in healthcare: the concept of empathy. It is human nature to judge, that cannot be avoided. But empathy requires one to understand the feelings of another, and, in the case of healthcare, to do our best to understand the ill and injured, and the suffering that has come upon them. We never judge. We are not concerned with what brought a patient to this condition, only how we can help them going forward. We do our best to heal, and to educate the patient so that this does not happen again. If the patient is truly damaged, be it from drug use, diabetes, or mental illness, there is an army of healthcare professionals that we will refer them to.
Believe it or not, when a patient leaves the facility, the empathy continues. We do not laugh and make fun of a potentially embarrassing condition. We do not judge behind the patient’s back. None of us do. In fact, in all of my work experience, we express pity, sadness that someone is going through life suffering. It is heartbreaking. Healthcare is not a job for the thin-skinned.
To be clear, we cannot sympathize, only empathize. To show empathy is to acknowledge another person’s feelings. It requires the emotional component of truly understanding, to the best of your ability, what the patient is feeling. You do not share these feelings yourself, but you understand the emotions the patient may be experiencing. Sympathy, on the other hand, means to share what the patient is going through, and to feel the emotions yourself. In healthcare, you cannot do that. You truly do not know the patient’s entire story, even though you learn much about them. You cannot sympathize, and present yourself as someone who shares the same suffering.
The concept of empathy is difficult to be taught in a training program. It is beneficial to be born and raised with this quality. How it it taught in a program is to simply learn about the illnesses and diseases, the suffering of the people you will eventually meet. Once a student understands what they will experience in the working world, the empathy starts to take hold.
During my training, when I learned about the legion of things that can wrong with the human body, my empathy grew stronger. Each of us in our own way is broken. Early on in my program, it gradually dawned on me what I would be doing and encountering on a daily basis. When I was much younger, college did not work out for me. But at the tender age of 47, making a bold career change later in life, I intended to take my studies seriously. I devoured the material. All of it fascinated me, and I knew I had made the right decision. It paid off, sure, with good grades and all, but school cannot prepare you for what you will actually see. I did understand there was no margin for error. In many vocations, if you make a mistake, it can be corrected, and the boss will yell at you. In healthcare, if you will pardon my drama, making a mistake can cause a patient serious harm, or worse. But my empathy gradually grew more into a sense of compassion; a desire to help others. It continued to grow.
I am very fortunate, in a way. I had found a job I love, in a field that continues to fascinate me. I have a job and a hobby at the same time. The human body is an amazing machine.
In 2021 I lost my father, just a few weeks shy of his 93rd birthday. A close family member was dealing with their own, ruthless demons. And I myself had grown somewhat despondent, as my licensing process (that’s a whole ‘nother story… every healthcare worker needs to be licensed by the Washing State Department of Health… usually a 1 or 2 week process, but in the Covid Age, mine took 3 months), and I wondered if anyone would hire a brand new MA like myself. But in a way, this strengthened my empathy, and my desire to help others, as you cannot give up on others if give up on yourself.
Then, I was extremely fortunate, and found work at a fantastic clinic. I was eager to get started, but a new MA is kept on a very short leash. But from the first day, I understood what my instructor was trying to subtly tell us, as he taught us the myriad of ways that a human being can suffer. I saw it first hand, the first day on the job, and I see it everyday, something new, something heartbreaking. I understood what my instructor meant when he spoke of empathy. The amount of suffering in the world, and the amount of people that need help, is truly staggering.
To be sure, much of what I see is fairly pedestrian to healthcare. A bad back, a sore shoulder, a nagging flu. They may be nuts and bolts to healthcare, but that does not mean the patient is not suffering and in need of help.
But much of what I have seen is truly heartbreaking. My personal emotional armor quickly developed, a necessity in healthcare. The suffering I see is my job. I signed up for it. And again, all of us feel for the afflicted. We do not mock the patient when he or she leaves. We acknowledge that we are saddened by what we have seen, and this inspires us to do more to help. All the while, your personal emotional armor must remain strong, or you will break. If you don’t have this mindset, you can’t work in healthcare.
One thing to consider: I work in a family medicine clinic. If a patient is beyond our clinic’s ability to treat, we refer them to a specialist; a cardiologist, a psychiatrist, an endocrinologist. There are those in healthcare who work in emergency departments, intensive care units, and Covid wards. The suffering I encounter does not hold a candle to theirs.
I have seen many things, horrible and fascinating things, in my new career. I have many stories to tell. I must hedge my words a bit. There is a law known as HIPAA (that’s for another time) that precludes me from offering specifics of a patient’s suffering outside of the workplace. So bear with me as I relate.
Healthcare has a habit of using fancy words for everything. If you have wax buildup in your ears, they need cleaning. But of course, this is known as impacted cerumen, treated with a lavage. There are several methods to this process, but the old tried and true is fill a spray bottle with warm water, loosen up that crap, and scoop it on out with a narrow probe. Oftentimes, and by that I mean all the time, the patient does not care for this. I operate as gently as I can, but that stuff has to come out! I use an instrument called an otoscope, and peer into the patient’s ear. Look at all that crap! Let’s get it out of there! A small container is held under the patient’s ear. As I spray, and the patient continues to look woozy and uncomfortable, the water drains from the ear…. full of unspeakable, horrible things. I peer with the otoscope again. Well! More gold to mine in that vein! Then comes the probe. You have to carefully get it in there (there’s fragile stuff in there), and scoop it on out. When I am finished, I try not to show them what I have removed, but they often see. I’ve seen patients gag. But hey, you can hear better now, right?
There is a common parasite called a tapeworm. It often strikes the very young, as they spend much of their time at day-care, or, as I like to call it, the plague palace. Well, the tapeworm likes to live in the intestines, and the colon, feeding off of whatever your digestive system is done with. I have assisted with the removal of a tapeworm. I will spare you the details of how this is accomplished. But again, empathy. Disgusting, yes, but I felt bad for the young patient.
I have not been working long, but I have assisted with circumcisions. The physician does the work, while I hand them instruments, adjust the light, and help hold instruments in place while the physician works. You can film your child’s birth. Sure. But I’m not certain you’d really want to film this process.
Most of the time, an abscess or a boil can be treated with antibiotics. Not always. The physician will inject a small amount of lidocaine (a numbing agent) near (or in… ugh…) the infection. The patient does not always take this well. However, once the area is numb, the physician can get to work. A small incision is made, and depending on the type of infection, it is allowed to drain. Sometimes it drains a lot. Never look these up on YouTube. Trust me. I hold the light for physician, and wipe away the drainage. There is a reason healthcare goes through so many gloves.
But it’s not all fun and games. Some of the worst injuries are ones you cannot see. This is where empathy is the most strongly required.
I was rooming a young person for a relatively simple procedure. The physician had checked this patient’s chart notes before the visit, something we both do, and something triggered in the physician’s mind to check this patient’s blood sugar. Before finishing up with the patient’s rooming, I checked their blood sugar. The glucometer read 300. Something must be wrong, I thought. I ran the test again. 300. I quickly finished up, and went to speak to the provider. The physician told me bring an A1C test, a test that measures blood sugar levels over the last 3 months, while she was with them. I took the sample, made my way to the lab, and secured the A1C results after running the test. I sent a private chat message to the physician, still in the exam room. She asked me to call in another physician. The poor patient had come in for a simple procedure. They left with a possible diagnosis of Type I Diabetes, a life-changing event.
I was rooming a patient once, who had come in for test results on their lungs. In my station, I am forbidden from telling the patient their diagnosis; it’s a bit above my pay-grade. But I could see the notes in the system: three malignant tumors on the patient’s lungs. They wanted to know the results. “Just tell me!” I knew what I was looking at. They did not have long for this world. I apologized, and told them the physician would be right with them.
Perhaps the most heartbreaking, hidden wounds that I cannot see, but I experience nonetheless, are those with mental health issues. In my short time, it has been shocking to see how many people are emotionally hurting. Granted, the Covid Age has inflicted damage on all us, in some way, but I had no idea it was so rampant. Often, I am asked to enter the physician’s notes, after the patient’s visit, concerning their mental health. My emotional armor is growing stronger, but I am still a human being. Some of the notes I enter are quite sad. I remember glancing at the patient’s age once. A young teen. Just a child, really, with dire mental health issues, and a hard life ahead of them.
However, myself and everyone I work with are drawn to heal and help others. We do our absolute best to heal the suffering, the pain that is so rampant. We want you to get better. We will do everything we can. But this is why you see videos of doctors and nurses, just finishing six days of twelve hour shifts, burned out and beaten up, sharing their stories, sacrificing so much to try, in their own way, to make the world a better place. One patient at a time.
But it is difficult work. There will always be suffering. And empathy will always be required.