The moment I stood in the anatomy lab holding a human heart in my hands, I was captivated. Its weight, both physically and symbolically, drew me into the beauty of anatomy. I was at a summer premedical program for high school students at my local medical school, and this experience with the human heart is what started my journey to becoming a physician. The heart beats three billion times in a lifetime, and I felt compelled to study its mystery.
Beyond a fascination with the physical heart, the science of compassion and empathy became one of my central passions. It amazed me that our word choice, our body language, and our eye contact can so powerfully affect how comfortable patients feel opening up to us. Compassionate communication is an essential healing tool that defines our ability to reach a diagnosis and collaborate with a patient to form a feasible treatment plan. Reminding ourselves that our patient is a person is the heart of medicine.
It was no surprise to me, then, that cardiology was one of my favorite blocks during the preclinical curriculum. During clerkship year, I chose cardiology for my internal medicine subspecialty elective and cardiothoracic surgery for my surgery elective. Something about the heart kept drawing me in. Every time I saw it beating in an echo, scrawling out lines on an EKG, thumping out its rhythm through my stethoscope, and skipping on the operating table, my eyes filled with tears of awe. Three billion beats, each laced with beauty, music, and intrigue.
After the first six months of clerkships, I got a call from my mom. “That’s weird,” I thought to myself. “She never calls during the day.” I glanced at my phone to see a text from her. “Granddad’s in the hospital.” I immediately called her back to find out that he had suffered a heart attack.
Suddenly, memories of all of my cardiology patients came flooding back. The echoes, the EKGs, and the cath images flashed across the screen of the workroom in my mind. My love for the heart suddenly fixated on one–Granddad’s. I talked my family through what the clinical team would do for him–how they would support him through the acute phase, and how they would catheterize him to get a picture of his coronary arteries. “Hopefully, they can stent something, and he can go home.” I rationalized that everything would be just fine, just like it was for my patients.
Every patient that had been just a patient to me suddenly became a person. I realized that all of the cases we had talked about on rounds were people—they were someone’s father, someone’s sister, someone’s uncle. And now it was my granddad. All I could think about were the physicians and nurses taking care of him. How were they viewing Granddad? I wondered how the resident would present him to her attending. “83-year-old man with no significant past medical history presenting with several days of substernal chest pain and an EKG with findings concerning for NSTEMI.”
It turned out that Granddad had severe multivessel coronary artery disease that could not only not be stented, but that needed a CABGx4. Mom put me on speakerphone every time the cardiologist or the cardiac surgeon came into Granddad’s room to talk about options. I was my family’s translator. I had to share hope and optimism from 3000 miles away while explaining what must sound like a foreign language to them.
Granddad was strong and healthy. He didn’t have a single pre-existing condition—no diabetes, hypertension, obesity—nor take a single medication (“the occasional vitamin,” I overheard him tell the cardiologist, which was met with a room full of laughs). He gardened outdoors for 4 hours a day. Because of this, the cardiac surgeon said he’d be a good candidate for surgery.
My mind immediately jumped from my cardiology elective to my cardiothoracic surgery rotation. This image was more visceral. Every saw I’d seen down a sternum, every injection of cardioplegia I’d watched with bated breath to arrest the heart, every deafening silence I’d felt as the grafted vessels were ever so carefully aligned and sutured into place—every sight, smell, and sound came rushing back to me. That would be Granddad. I had not feared the heart attack or the catheterization, but surgery worried me. Everything became more real. As 83-year-old Granddad went in for his CABG, I stood in the OR of an 83-hour-old baby for her congenital cardiac surgery. The significance was not lost on me. I looked down at her tangerine-size heart and thought of Granddad’s.
After his surgery, Granddad never quite got better. Everything that was once a molehill became a mountain—dressing, walking, talking, breathing. He worked every day on his incentive spirometer, he did his laps, he visited his grandchildren. I saw firsthand what we never see in the hospital—the aftermath. For the first time, I tried a sip of the Ensure protein shakes we’re always forcing patients to drink, giving me a newfound appreciation for patients persevering through its density. I saw how hard it was for Granddad to do everything he had once done effortlessly. I saw the toll it took on Nana and on my parents. I saw how it pained Granddad. He was never someone who wanted to live this way, and he had always made that clear to us.
A couple of months after his surgery, Granddad got pneumonia and passed away. His heart had reached the end of its three billion beats.
Everything that happened to Granddad completely changed how I look back at my clerkship experience. The patients whom I studied so diligently became people. My own heart sank as I thought of the countless presentations I had begun with “XYZ-year-old man presenting with…” Of all people, I was the one who had written my entire undergraduate thesis on compassionate care, and I still felt that I hadn’t appreciated the personhood of my patients enough.
This is the eternal challenge at the heart of medicine. How do we remind ourselves that our patients are people without feeling the suffering of every patient as if they are our granddad? This is where the science of compassion enters. Compassion is the ability to notice the suffering of another, be moved by it, experience a desire to reduce it, and take action to relieve it. Distinct from empathy, compassion requires maintenance of the self-other distinction so that we can remind ourselves that our patients are human and use that reminder to energize us, not paralyze us. Compassion can be trained and cultivated to improve the way we deliver care and buffer our own well-being against burnout.
It will take me a long time to see the hospital the same way again. Every time I hear about pneumonia, SNFs, and incentive spirometers, I think of Granddad. Every time I see an Ensure protein shake sitting untouched on a patient’s tray, every time I scrub into a surgery, every time I watch a heart squeeze out a fraction of its three billion beats on a screen, I think of him. This does not have to be a bad thing; if I view it through the lens of compassion, this can motivate me to take care of someone else’s granddad with the love that they deserve. It takes compassion to channel that reaction into care.
Granddad chose to donate his body to science–in fact, to the same local medical school where I first stood in the anatomy lab seven years ago. Today, as I sit on a bench at the memorial for the donors, I cannot help but wonder if his courage will inspire others to go into medicine, to accompany people like him and families like his through their journey of healing and hope. This is the heart of medicine, and this is why I stayed.
Aidan Crowley is an CDY3 at the Perelman School of Medicine.
Art by Andrew Lin, an MS3 at the Perelman School of Medicine.
