I remember one day a few years ago when I was talking with one of my friends about the challenges of being a doctor after a tough day at work. I had seen a large number of patients within the span of a few hours, and in addition to many of them being sick, I dealt with family members who had so many questions and who wanted to provide me more historic background about why their family member was in the hospital. I would try to patiently listen, but at times, I found it overwhelming since having so much interaction with other people was contrary to my introverted personality, the kind that preferred to be by myself in the midst of so much perceived chaos. I asked my friend, in a lamenting tone, why did so many people want to talk to me? Didn’t they realize that I was pressed for time and that I had so much to do? After I finished complaining, my friend told me, in a non-judgmental way, that I entered into a profession that by default brought forth a “sacred trust.”
“That’s why people want to talk to you; the white coat you wear, the demeanor you bring with you, and the reputation of the profession you entered allow people to trust you quickly. It is a sacred trust that comes with great responsibility.”
Sacred trust. Those two words stayed with me throughout the rest of the day, mainly because I was trying to figure out what my friend meant. What was ironic was that this was a member of the clergy telling me this; if any profession deserved to have those two words describe it, it was my friend’s profession, not mine. What was sacred about the interaction between a patient and a doctor? I could understand the trust aspect of the relationship, but a sacred aspect to it? My understanding of sacred had to do with encountering the divine, a sort of holy engagement of the senses. I ascribed it to things such as prayer, communion and liturgy, events within a religious context that I encounter on a frequent basis at church. So how could these two words be applied to medicine?
The more I’ve thought about it over the years, the more I realize that medicine is inherently a profession of vulnerability. We meet patients at their most vulnerable times, and inevitably there is a realization that only a privileged few have the knowledge to help improve their health, a most personal aspect of an individual. In the patients’ vulnerability, there is a realization that hiding certain aspects of their lives could potentially hinder their care. So conversation begins to take place as they gauge how much to tell us. As the conversation progresses, more aspects of a patient’s life are shared and these aspects become more personal. After a certain point, if enough trust is established, a conversation occurs as if two friends are talking, since the initial wall between doctor and patient is broken down, and as such, more intimate things are shared. It is in that intimacy that the sacred trust manifests, and unfiltered conversation happens, even if it is just for a little while. If we pay attention, we may find out that we are in the presence of a world-renowned author or a person who is one of the few people remaining from a generation that fought in World War II. These details do not come up initially and in most conversations would only be reserved for a select few, but somehow, doctors can become part of that select few in a few minutes when it usually takes a longer time for others. Without expecting it, I met both of those people all because of revelations from them in the setting of a sacred trust.
When I think about all this, it makes more sense for the word “sacred” to come into play. In a sense, we are coming in contact with patients and their real souls. We learn about what makes them tick in those moments of vulnerability. It is in that vulnerability where true intimacy takes place, and we learn more about one another in a few minutes than some people learn about others in a lifetime. When I think about those prior religious events that I mentioned earlier, I am bringing my whole soul to those moments, and that is what makes those events sacred to me. Perhaps in realizing that a patient may bring his own soul to me as a physician, in a moment of vulnerability, I can begin to see how medicine can foster a “sacred trust.”
Chiduzie Madubata is an internal medicine physician.
