The false narrative of choice.
S Luckett G.
‘Miss,’ she said, as I bit my tongue. I was choking on the worst insult a female junior doctor can bear, ‘I know that crystal meth is really my problem. I’m going to quit the meth.’
‘Love,’ I started, a reflex term of endearment for the wretched young woman in front of me, ‘What I need you to do is dry out your socks at night.’
She was tweaking in front of me, her eyes wild and her feet wet and macerated from her unwashed socks. She was earnest and somehow sweet despite the holes burned in her teeth and the scabs she had relentlessly picked on her face, arms, and legs. I was a bit afraid to touch her. But when I looked into her huge, nearly-vacant eyes, I also wanted, badly, to give her a hug.
They tell me that I’ll get over that as I become more senior. With increasing experience in seeing patients who abuse substances, I will become inured to the pathetic faces they present to the emergency department. In time, I won’t care so much about the intoxicated guy in Room 9 who the nurses all hate; he comes in once a week, hurling abuses, and then leaves against medical advice when he needs his next fix. When I’ve seen more patients, I won’t waste my time on the tweaking addict who believes there are threads embedded deep inside his skin and shows me his abscessed track marks as proof. With experience, I won’t want to hug the addled young woman addicted to meth and covered in open sores, looking over her shoulder and telling me about how she really will get off meth tomorrow.
Amongst my colleagues, there is a false narrative of choice. Smart and well-educated individuals construct a life story that reads as a series of decisions. The narratives they construct for others are similarly linear.
I know that as a successful young professional, I contribute to this narrative, especially because I come from a troubled background. In a sense, my story is evidence that overcoming adversity is a matter of personal fortitude. People like me are proof that we create our own stories and are not bound by the haphazard circumstances into which we are born. But this narrative of personal agency we cleave to is not a narrative of choice; it is the narrative of privilege.
I imagine what it would be like to be trapped in the choices I made as a teenager, when my prefrontal cortex was still cooking and I couldn’t see beyond the five minutes ahead of me.
When people, often teenagers, make choices to use substances, they do so for a variety of reasons. They make a choice that then excludes them from interacting with mainstream society for many years to come, perhaps for their whole lives. Some do get clean, and fewer still stay clean, but many remain trapped in choices they made when they were 16. It’s like being forced to wear the dyed hair and flared fleece pants you chose when you were in grade 11, only the consequences are much graver.
I was the recipient of immeasurable luck and privilege, and, if you are reading this, you were too.
Maybe with time and experience I will lose the love and compassion I felt for that scarred young woman with macerated feet. Maybe I will forget her humanness. Maybe I will no longer be able to forgive the carelessness with which she treats her body and mind. But, if I do lose that part of me, if I lose my understanding of our false narrative of choice, I will be worse for it.
This is an extract from the full article on the PLOS Public Health blog, cross posted from the author’s own.
Luckett prods one of the dominant current themes of writing about the practice of medicine: compassion fatigue, self-protection, the impossibility of being constantly empathic without precipitating burnout. Yet these are balanced against the need to have enough of it to do your best for your patients; and for yourself as a human being, to continue to find reward and value in practising medicine.
Many experiential writings about practising medicine are around this theme, and some, like this one, concern patients who pose particular challenges to sympathy, and may generate despair. The comments beneath this article in the various places it has been posted and re-posted are moving.
- The author is a trainee in emergency medicine in Canada. Her writing can be found in her blog, if it becomes public again, where this article first appeared in 2015. Twitter @SLuckettG.
- The comments beneath the post at PLOS are worth reading.
- The article is also reposted with more photos but fewer comments at Kindness blog.