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A Piece of My Mind
October 22/29, 2019

You Did Not Teach Me What You Thought You Did

Author Affiliations
  • 1Durham VA Healthcare System, Duke University, Durham, North Carolina
JAMA. 2019;322(16):1555-1556. doi:10.1001/jama.2019.15849

Ring the bells that still can ring.

Forget your perfect offering.

There is a crack in everything;

That is how the light gets in.

Leonard Cohen1

This is not the story of my leukemia diagnosis, nor of my subsequent stem cell transplant. Those are harrowing stories that make excellent Facebook click bait: “A mother of three!” “A doctor herself!” “Diagnosed at Christmas!”

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    19 Comments for this article
    Thank You
    Jacob Towery, MD | Private Practice, Adjunct Faculty at Stanford
    I wanted to say that I found your article so beautiful and moving. Tears are flowing down my face. I'm so sorry that you have gone through so much pain. I'm so glad that you are still teaching. Thank you for your vulnerability and authenticity and lovely writing.
    The Person inside of the Patient
    Patricia Mayro, M.A., CCC-SLP | University
    Thank you for sharing your hard-won wisdom about seeing the person inside the patient (or the doctor, for that matter). It is so tempting to rage in the face of human finitude, but I believe, with you, that it is far better to link our humanity with those we care for...and ring those bells!
    Thank You
    Donald Costic, MD | Previous APD
    When I was teaching house staff I made it point to educate what it means to be an individual in medicine. I was never sure if it meant anything. Did it anyway. Your story sheds light on the fact that it may be more important than I will ever know. I wish you well my friend. I’m proud to call you a colleague.
    Thank You For Beautifully Telling Your Story
    Nancy Morris, PA-C | Retired
    We were told in our training to separate our personal lives from our medical practice. Your story demonstrates how compassion for our patients is often developed by our own life experiences. We become better at what we do because we have empathy for what our patients are experiencing and we treat the whole person, not just their medical problems. I believe God can uniquely use our past or present experiences to help our patients as they face medical illness and its associated emotional challenges. After retiring from 40 years of family practice, the memory of this deeper connection with my patients is what I enjoyed the most in my medical career.
    That Cannot Have Been Easy
    Rajagopal MR, MBBS, MD | Chairman, Pallium India (palliumindia.org)
    It cannot have been easy to write this piece. Maybe you relived every agonising moment as you wrote each sentence. Yet you did, and gave us a little bit of yourself, to remind us that a doctor is also a human being. That it is not easy for anyone of us to look at oneself and see even what is obvious. That often we need someone else to help us to see ourselves as we really are. And that it is never too late to give. Thank you and as we say in India, namaskaram (I bow to the divine in you).
    Beautiful Story
    Elias Hilal, MD | Allegheny General Hospital, Otolaryngology
    Beautiful writing. Thank you for sharing your experience, and a horrendous one at that. You personify the human side of medicine and teach us all what it is like to be a patient and a physician at the same time. I wish you well in your ongoing battle. Keep on teaching, ...all of us.
    You Taught Me Much More
    Marion Eckmiller, PhD, Priv. Dozent | University
    "You did not teach me what you thought you did," you taught me much more-- for which I sincerely thank you.

    As individuals devoted to healing, we may occasionally encounter a novel source of valuable insight and wisdom. Having found one such gem, I strongly recommend that all potential healers read Marshall B. Rosenberg's book Nonviolent Communication, 2015, Puddle Dancer Press.
    From a Fellow Doctor
    Jeffrey Ditesheim, MD | Private practice
    Your courage to pen these very personal and raw experiences is so meaningful. As a doctor and a surgeon, 35 yrs since graduating medical school, I am old enough to have cared for many, supported my father through cancer, and realize my own mortality.

    Wouldn’t it be nice if choosing medicine as a career bestowed on us some special protection from illness. Doctor or patient, it’s not binary. The privilege of health is never guaranteed even for doctors. At first we learn to separate our feelings and distance our emotions because we wear a white
    coat and have taken an oath. Later we fantasize that because we have spent so many hours in the hospital or operating room, we have earned “immunity”. That we will never have to be a patient. But it is just a fantasy.

    Throughout a career we focus on perfecting our abilities. We always want to be able to tell a patient that our intervention will mean the difference between sickness and health. We somehow convince ourselves that being a more perfect doctor or surgeon will make the real difference. But what about the person who has a successful operation and doesn’t get well. Have we failed?

    How do we train young doctors to perfect their abilities in medicine or surgery and remember that every patient is a person with a story: a life before sickness? How do we help young doctors to understand that their best abilities may not bring “success”.

    There is so much to learn from our peers, our mentors and our patients. When our mentors or peers become patients they have so much to teach all of us. Our true responsibility as doctors is not to be perfect but to have humility that the patients we treat are fathers, mothers, sons,daughters, spouses or partners all with dreams that changed the moment they were told they were sick.

    Thank you for your sharing, I pray for your health and thank you for the gifts you have given.
    Thank you for your insightful essay.
    William Bradnan, M.D., M.S., M.A. | Retired
    Retired, and with thrombocythemia and now a provoked DVT from a fall at home, I can appreciate what you say about the roles of a healer. Your essay is very nicely written and reminds us that not all of medicine is about facts and figures. Thanks again for sharing your thoughts with all of us.
    Bringing all of ourselves to work
    Soo Borson, MD | University of Washington (Professor Emerita)
    Thank you, Dr. Carlson, for breaking the ice with your painful and helpful story. There are no checklists for these experiences, only face-to-face encounters with life as it is. Were more of us to bring our full selves to our work as doctors, think of how our care would change, the lifetime bonds we could form with students on the strength of just one conversation, and the kinds of research questions we would then be compelled to ask because they’ve taken on such new urgency.
    Your voice, Our voices
    Lesley Shure, MD, DPM |
    As I read your essay, it felt like you were speaking also for me. A serious chronic illness ended my career, and at times it has taken my voice. Thank you so much for writing. May your memory continue to raise up everyone whose life you've touched, for as long as you are here and long after you/me/we are gone.
    Thank you!
    William King-Lewis, BA, MD | FMR NHCP
    Fantastic piece. I cannot agree more. Most of my education has had nothing to do with the medicine. None of what I can teach medical students, interns, and junior residents has any relation to science but yet the occasional “thank you for telling me about/how/when about xyz” makes it worth it. To hear your affirmation is some good comfort as I hit my mid-year lull on return to residency. I wish you the best and can’t thank you enough for sharing your intimate and personal story!
    "Put your hand up if you have ever been a patient"
    David Power, MBBS MPH | University of Minnesota Medical School
    Thank you for your sharing - really well written, so efficient and clear. I was just at a medical conference when a presenter asked - to illustrate a point - "put your hand up if you have ever been a patient". It was confusing - I think he actually meant "if you have ever been a really sick, hospitalized inpatient". As someone else has commented here, it's not binary whether we are either a doctor or a patient - indeed we are all "patients" - at some level, even the healthiest among us. Health and lack of health are more continuous than they are categorical variables. And, yes indeed, the "hidden" curriculum often teaches much more than is in the syllabus. Thanks : )
    Moved Beyond Words
    Consuelo Sague, MD | Florida International University
    Surely you must know how powerful, how terrifying, how healing your insights are. I am glad that you got your young colleague to share with you what your words meant to him. I hope you believe how powerful your words are. I am moved beyond words.
    The Best Way for Students to Learn is to Witness their Teacher Learn
    Anthony Kovatch, MD | Allegheny Health Network, Pittsburgh, PA
    "In some ways suffering ceases to be suffering at the moment it finds a meaning, such as the meaning of a sacrifice" wrote Holocaust survivor and existential therapist Viktor Frankl in "Man's Search for Meaning." I think the extraordinary self-disclosure of your journey takes this principle to a new and higher level.

    Life is full of irony and events that travel full circle. I have found that it is indeed the little things we do that patients and students most remember.

    The courage that you have taught us all in your essay surpasses all the knowledge espoused
    on all the podiums of all the institutions of medicine and gives stark credence to the educational "pearl": The best way for students to learn is to witness their teacher learn. Thank you for an unforgettable lesson!
    Thank you for Showing Up
    Bradley Katz, MD, PhD | University of Utah Health Sciences Center
    Dr. Carlson, thank you for sharing your story. I too am grateful to have had the experience of having a student thank me for something I taught them, but have also been surprised at what they had learned. What stood out for me as I read your story was that despite your illness, you continued to "show up" for your family, for your colleagues, for your patients and for your students. And that in itself is a powerful lesson for students.
    Too Bad
    Henry Larsen |
    The following comments may seem awfully contrarian to the author and many (most?) of the readers here but I have to say what I think. After 30 years on the ward as an RN in our local university (teaching) hospital, 'head nurse' for the second half of that tenure, I completed a PhD -- in Nursing Science -- and switched over to lecturing in the nursing school. With that background, I couldn't help but feel solidarity with and annoyance on behalf of the nurses in Dr Carlson's hospital, specifically those who were expected, like furniture, to help her cover for her inability to carry out her duties: "When I couldn’t reach over my head to set up suction, I pretended I didn’t know how and asked a nurse for help." Believe me, Doctor, those nurses were not fooled by your pretense.

    This article begs for the natural human sympathy that one would expect for a cancer sufferer. Dr Carlson of course deserves that sympathy. But it also displays a sense of entitlement and reflects a power imbalance that is all too shamefully representative of American health care. Too many nurses are on zero-hour appointments whilst too many doctors waft through the wards waiting for patients (patients!) to pick up their dropped pens. It is for shame.
    The Art of Living
    Gabriel Pardo | OMRF Multiple Sclerosis Center
    There is, no doubt, a different perspective on life and sickness when one deals with maladies, broken bodies, and broken souls on a regular basis. We seek the root of the illness, we elaborate therapeutic strategies trying to include all the variables -scientific and mundane- we attempt to inform and engage the sufferer and his/her loved ones on the vicissitudes to come, and we take respite on the notion of a job well done. But two questions remain: are we truly reaching the sufferer, and do we forget we physicians inhabit the same faulty-prone body as anyone else? So, how do we transcend the objective, calculated, evidence-based approach of delivering healthcare and simultaneously have a positive impact on an individual's life beyond the direct act of healing or palliation? And how do we apply that to ourselves? Dr. Carlson gives us a beautiful look into it. We teach -and we learn- in an informal way. A way beyond lectures, textbooks and journals. We learn every day, at every encounter, and from every person we interact with. We need to practice the art of living ...and we, healers, do so in part through the art -not only the science- of practicing medicine.
    Thank you
    Edson Boasquevisque, MD, PhD | National Cancer Institute of Rio de Janeiro, Brasil
    Thank you for sharing your life story with all of us. Certainly all who read it will have like me, a great opportunity to make life refletions for many times and know that we are just passing. We did not came to stay.