Physician and author Dr. Jessica Zitter shows “How Storytelling Can Help Young Doctors Become More Resilient” in her recent essay in the Harvard Business Review. We know that this issue is vital to increasingly stretched and stressed medical providers, the consequences of which are discussed in previous Narrative Medicine Monday posts here and here. I wrote a short piece in Pulse for their “Stress and Burnout” issue that outlines a typical day for a modern primary care physician and have also studied and taught narrative medicine as a tool to better care for our patients and ourselves. Zitter has a unique perspective on the particular challenges for physicians and patients in end of life care, given she is board certified in both critical care and palliative care medicine.

Zitter addresses this issue through a “new program which uses storytelling to help young doctors reflect on how they handle the emotional and psychological toll of caring for suffering patients.” She opens up to a group of new physicians about running the code of a young woman in the ICU, the resistance to letting a patient go, even when nothing remains other than suffering: “We are expected to be brave, confident, and above all, to never give up.  And all the more so in particular cases, such as when a patient is young, previously healthy, or has a condition that appears reversible on admission. And in cases when our well-intended but risky interventions might have actually made things worse, it is almost impossible to let go.”

When the experienced Zitter suggests that they instead institute pain management and sedation rather than attempt resuscitation the next time her heart stops, the physicians-in-training bristle. She questions a culture that promotes doing everything, including “this technique, that intervention, a whole host of options that would never have saved this woman.” Zitter admits she gives in to the other physicians, decides to fight “to the end, the way real heroes do.” The result is tragic. “The patient died a terrible death.”

Zitter reflects on this experience and shares it in the hope that it will help other young physicians who will certainly encounter the same, given that our culture and medical training makes it so “we often feel unable to question or diverge from scripted approaches — ones which may actually cause more suffering than benefit.”

To combat this, Zitter looks to storytelling, asserting that “[d]ata show that the use of stories to process the challenging experience of being a doctor increases empathy, enhances wellness and resilience, and promotes a more humanistic health care culture.” After Zitter shares her story with the group, others begin opening up about their own experiences and a “genuine conversation proceeded, one which addressed the emotional pitfalls and psychological challenges of this work.”

Zitter is also part of a 2016 Netflix documentary called “Extremis.” This short film takes a hard look at the grueling decisions patients’ families, and the physicians who inform them, make near the end of life in the ICU. In it, you can appreciate the need to “provide safe spaces for healthcare professionals to reflect on and process their own suffering. Then we will be fully available to do the hard work of patient-centered decision making in the moments when it is really needed — at the bedside of a dying patient.”

Writing Prompt:  Have you had to help make decisions for a patient who is critically ill in the ICU? What issues came up? How was your interaction with the medical team that cared for your loved one? Alternatively, consider watching the short documentary “Extremis” and write about a moment that struck you or perhaps changed your way of thinking about end of life care. If you’re a medical professional, think of a time you witnessed an end of life situation when the patient experienced more suffering than was necessary. Do you agree that our culture contributes to performing “risky interventions” that “might have actually made things worse,” because we insist on fighting “to the end, the way real heroes do?” How do you think sharing such stories might promote wellness? Consider writing about a challenging situation from the perspective of the attending doctor, the resident, the patient, the nurse, the family member. Write for 10 minutes.