As a doctor, what inspires you
Dr. Rainer Jund on empathy: "Even a doctor always remains a patient"
Fear and hope, despair and relief - and also frustration again and again: In everyday clinical practice, doctors are confronted with extreme fates and emotions. With "Days in White" the ENT doctor Dr. Rainer Jund processed his experiences literarily. The focus is on the field of tension between empathy and professional rationality.
“I was the final authority. My craft decided. If I fail now, a child will die. A situation that can theoretically be imagined as a doctor, but is never tangible in practice. ”These thoughts run through Jund's first-person narrator when he is called for an emergency. Coffee and walnuts in the nurses' room, now emergency surgery for a seven-year-old girl who is bleeding profusely from her mouth. Jund finds plastic words for the panic that rises in the young doctor - and at the same time describes his struggle for a professional attitude: “Why me? Why me? Why me? What a hell of a shit. In such situations, the distance to the role must not slip. I am the doctor. Ignore the screeching monster. Rationality".
How vulnerable human life is always resonates in Jund's book - for example, with a boy who fell from a tree climbing and is now losing a lot of blood - until his heart suddenly stops in the shock room: “The miracle of Life is tender. A millimeter-thick blood vessel in the nose decided about survival, about school, partying, going to the sea, studying, crying alone under the covers in the evenings, lovesickness, becoming a father ”. In “Days in White” there is no guarantee of a happy ending: some patients can save the doctors, others not - just like in real everyday hospital life. Fates come and go. The reader rarely learns how a patient's life goes on after a hospital stay - an experience that hospital doctors also have all the time.
In episodic form, Jund lets his readers take part in the everyday work of a young doctor: From the first prep course during his studies, he continues up the career ladder through his internship - in the end he is senior physician. The reader doesn't even notice how the years go by. The focus is on the scenes that the doctor experiences with his patients, and which develop an unusual emotional impact due to the clear, often concise style of the author. Sometimes the first-person narrator fights for the life of a child, sometimes he almost loses patience with a patient who blames American chemtrails for his otitis media.
Dr. Jund, you are a doctor yourself and worked for a long time at the ENT University Clinic in Munich Großhadern. Why did you put your experience as a clinician into a book?
Dr. Rainer Jund: The profession of doctor is so beautiful and so intense, but it requires all the attention and intensity of a person if you want to practice it seriously. This attention and intensity is lost in the daily routine of the clinic, especially the emotional processing. That was the reason for me to take another closer look with the special instrument of literature.
Why is the microcosm “hospital” also literarily exciting for you?
Dr. Rainer Jund: The hospital is an image of the world. How people live and work there - regardless of whether they are doctors and patients or doctors among each other - reflects the whole of society on a small scale. There are similar hopes, similar hardships, and similar sorrows. However, all of this is extremely condensed in the hospital: human suffering, help and hope, but also friendship. We find a very focused picture of the world here. For someone who writes and wants to think about it, this is of course extremely interesting.
How strongly are the patient fates you describe inspired by real role models?
Dr. Rainer Jund: The book is clearly literary fiction, but of course it is colored autobiographically. On the one hand, this applies to the curriculum vitae of the first-person narrator, which can also stand for any other doctor. The individual patient stories can have happened in the same way. From a technical and sociological point of view, it's all very realistic, but maybe it didn't happen to exactly these people.
Your first-person narrator accompanies us from his first prep course during his studies to his time as a senior physician. How would you describe its development over this period?
Dr. Rainer Jund: The first-person narrator begins like a medical student, full of motivation and passion. He is extremely excited about the idea of becoming a doctor - with all the reputation that this profession has in society. He enters a new world that also tears him out of his youth and sheltered reverie of his previous environment. Suddenly he experiences this situation in the prep course: It's no longer fun, there is really a dead person lying there. This is a tremendous experience, but one that you don't have alone, but in a group. These acquaintances that you make in the dissection course are incredibly intense and they are often friends and acquaintances for life. It's almost like a mercenary force being thrown into a world that can also be hostile, and you have to rely on each other. This is followed by episodes of learning for the first-person narrator, who initially goes into neurosurgery. He learns and experiences how close life is to the abyss and how close sometimes suffering, joy and hope lie to one another.
This vulnerability of human life is a central motif of the book. What does it do to you as a doctor to be confronted with extreme fates on a regular basis?
Dr. Rainer Jund: In the clinic there is constant going back and forth between the most absurd diseases that can mean everything or nothing to people. A very normal reflex then arises in a young doctor: You want to and have to learn. The technical competence can only arise if we face the experience of these diseases. It is important for doctors to perform operations and experience fates. But this technical competence has a price. For many, the emotional level, the empathy, remains very much behind. Many doctors react with mechanisms such as resignation, flight or cynicism towards the patient.
Keyword empathy: In your book there are doctors who react empathically and others who do not. What role does empathy play in everyday hospital life?
Dr. Rainer Jund: A major role. When a doctor responds with resignation or cynicism, it is popularly described as "jaded". In reality, these are defense mechanisms designed to protect people from suffering all day. Perhaps, as a doctor, you can no longer react empathically when someone asks "Is it cancer?" For the umpteenth time a day. Perhaps this is the only way a doctor can survive in his role. Young doctors like the first-person narrator have to process certain numbers of cases for their specialist training. Of course, there are people behind the cases. But in order to be able to act professionally, you sometimes have to push this knowledge into the background. In the further course of learning, there is only a flight of highs. But then there comes something that is extremely essential to becoming a good doctor. And that is an experience of humility. Then you know that you can only try to help - but there are no guarantees, even if you are perhaps the greatest expert in your field. The earlier one has achieved this humility, the better one becomes, can treat one's patients well and the less one as a doctor has to resort to cynicism and resignation. If there was a course that deals with the stories and the diseases and what is behind them on a human level, it would save both doctors and patients a great deal of suffering.
Do you have to isolate yourself to a certain extent in order to do your job as a doctor justice? Or not right now?
Dr. Rainer Jund: As a doctor, one is much more aware of the vulnerability of human life. But are you really paying attention? I've been trying to distract myself from it for a long time. Perhaps there is a fear that professionalism in one's own actions will be lost if the thought of vulnerability becomes too great. It is a field of tension between empathy and professional rationality. If you get in an emergency, you have to act quickly - there is no time for empathy at first. Nevertheless, there has to be that minute afterwards when you think about whether it went well and who the patient was, etc. If you don't do that, empathy eventually falls by the wayside - but this is something that people need. You can't turn it off for eight or ten hours a day and then go back to the family in a good mood after work. You have to allow yourself to be allowed to reflect on your feelings. So far there are few rooms for this. Fears are commonplace. If you can classify them well, they are part of daily perception. Everyone has fears.
"We are all patients" it says in the dedication of your book. As a doctor, do you sometimes think that you might as well be the patient?
Dr. Rainer Jund: Of course, we are all patients, that is a very elementary thought. Of course, doctors are also patients, usually very difficult and bad patients. Because they do not accept that their own knowledge cannot help them. I am a very bad patient myself, especially when it comes to my family and my children. You cannot accept that you are powerless and that you can suffer exactly the same fate as everyone else. One should try to treat each patient as one wishes for oneself or one's family. This change of perspective is extremely important for doctors. Unfortunately, the thought “You are only a patient” often gets lost in our profession.
What advice do you give young doctors on the basis of your professional experience?
Dr. Rainer Jund: There is very specific advice. As a young doctor one should be aware that the biggest obstacle is overconfidence. This overestimation of oneself stands in the way of the real gain of knowledge and also the actual obligations of a doctor. If we want to form a trusting society, we all have to keep learning for a lifetime and not believe that we already know everything. This is particularly relevant for a practicing doctor. The hubris of doctors is certainly one of the strongest quality-reducing factors in a health system. It would be extremely bad to always use your own perspective as a yardstick for everything that is important.
Rainer Jund, Days in White
© Piper Verlag GmbH, Munich, 2019
240 pages, hardcover
Price: 20.00 euros
This article first appeared on operation-karriere.de, the online portal of the German Medical Publishers for medical students and young professionals (October 2nd, 2019).
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