“Play piano and sing.”
“Take a walk.”
“Pet my cat.”
Lucille Marchand, a professor of family medicine at the University of Wisconsin School of Medicine and Public Health, has asked the medical students in her Healer’s Art class how they take care of themselves – what they do to unwind from the incessant stresses of studying medicine.
The delightfully broad range of responses will become the groundwork for a formal discussion of how to remain human, sensitive and open despite the rigors of the doctor’s life.
Taking care of yourself is seldom – if ever – formally discussed in medical school.
But when Marchand became a doctor during the early 1980s in San Francisco, doctors-to-be were in physical danger. The city was the epicenter of the AIDS epidemic – and AIDS was then a death sentence.
“All of us were scared that we would die in medical school,” Marchand tells the class. “We were just one needle-stick away. Many people dealt with being scared by shutting down, taking care of the X-rays and blood draws without doing a lot of listening. Giving comfort wasn’t in the job description.”
And although the prognosis for AIDS has improved dramatically since those days, uncertainty and the fear are always part of medicine, she implies. “It was a time when we did not know what to do; when we were learning what to do when we did know what to do. Even today, the answers are not always in textbooks,” she says.
Marchand, who specializes in palliative care – comfort care at the end of life – is teaching the class for the tenth time in Madison, and she recognizes that medical school will never be easy. “Sometimes we feel lost in this chute of knowledge. It’s important to remember to reconnect to your wholeness in times like that.”
About 30 people are in the room, and when Marchand asks the physicians to talk to the class, a dozen get up. These are doctors who are back for a second helping, who will serve as mentors to the early 20-somethings who are in their first or second year of medical school.
They also acknowledge that they see themselves as fellow explorers of the awe, mysteries and stresses of practicing medicine.
“I need this process,” Jim Shropshire, a family physician at Meriter, tells the class. “This is my ninth year in the class. Think of how busy we get, we expend ourselves and need to be constantly reminded that we have to care for ourselves as physicians and healers.”
“I’ve done this multiple times, and I keep coming back,” says Anne Kolan, a clinical instructor in family medicine who specializes in alternative treatments for chronic conditions. “There’s a mystery of life, and this is a great class to explore it.”
The Healer’s Art was originated by Rachel Brenner, a psychiatrist who practiced in the Bay area during the AIDS epidemic. The course is now taught in 70 medical schools worldwide.
Dana Dieringer, a medical student who’s taking the course for a second time, one highlight is when faculty “share a moment where they have had a hard time, or question their decision-making. Ideally, you never have to question a decision you make with a patient, but the reality is that everybody has worried that they were not good enough at some point.”
The class, she says, “Is not like any other classes, but it’s my favorite.”
Marchand, who was already a nurse when she forged her medical roots in the crucible of the AIDS epidemic, remembers people dying horrible deaths while doctors stood by, helpless to stem the ravaging opportunistic infections.
“It was a transformational experience that led me to this work,” says Marchand. “Even the dark times have lessons for us. When I take care of patients in the hospital, they are in crisis. If I melt into despair, that’s not going to help. It’s much better to be who I am; to be sincere, authentic, to bring all of that so people will know they are in the presence of a human being.”
Healer’s art addresses two fundamental challenges for healers, she says. “How do you remember your wholeness so you can stay a complete human being? How can you take care of yourself so you retain your humanness, so you can be sensitive to someone’s pain?”
University of Wisconsin School of Medicine and Public Health