Ethics Case Conference

Last week, I finished my first course -- Intro to Clinical Decision-Making (ICDM), essentially a conglomerate of epidemiology/biostatistics, genetics, and ethics. I honestly wasn't looking forward to the ethics part, as important as I knew it was. I didn't want to confront the difficulty just yet; I didn't feel ready. But the ethics lectures were delivered by one of the most inspiring people I've ever met. A pediatric palliative care specialist who could not have been more simultaneously profound, thoughtful, gentle, and inspiring. I actually got teary-eyed during several of his lectures -- at so many instances, I was prompted to reflect on why I'm here in the first place and my goals for taking care of patients. As part of the course, we were also required to go through the process of completing an Advanced Directive (I need to re-do mine... when I do it again, I'll write about it. It was so unsettling -- not for spookiness' sake, but for the lack of resolution I have about really how I want certain situations handled). After I did my AD the first time, I profoundly appreciated that there is so much ambiguity as it relates to what decisions people can make, when they can make them and under what conditions -- and it scared the HELL out of me. I'd seen the flipside of all of this at The Forensic Panel -- mostly family members trying to weasel one another out of money by challenging their loved one's decision-making capacity, etc. -- but nothing at the crux of the precipitating factors leading up to that decision. I freaked out. I needed resolution. I emailed this guy and asked him for how I could observe this stuff first-hand, stat. He invited me to attend a committee meeting of the ethics group, which was to take place a few weeks later.

That was today.

I was nervous. I woke up this morning, anxious about being a first-year medical student popping into this "place I don't belong." I got dressed up, to try to psyche myself up for "belonging." I got to school and started making excuses about all the other stuff I should do during my lunch break (which was when this conference was to take place). I went all the way out to the hospital -- and was about to chicken out. Finally I walked in. Introduced myself. Remained calm. "I belong. Pshh, yeah, I belong." It's all about how you talk to yourself.

The group was informal. Ethics supervisor, a peds resident, a 4th year med student, various nurses, and some administrators. The Ethics consultant presented two cases that were recently called in for Ethics consults, and the group discussed them. I was entirely passive -- I had nothing to contribute, and just wanted to soak things up. I was mindful of the fact that, if this were a med school class, "people" (maybe not me) would share their views readily -- as though they knew what they were talking about.... and that, here, I was so mindful of this being "real life" and not a hypothetical example. I didn't trust my views, and that's okay. But what was really amazing was that the structure I'd learned in my classes was actually applied to real life, exactly as it had been taught to me. I felt grateful at how well I am being taught.

I plan to attend more of these conferences -- and maybe, just maybe, I might one day have the confidence to open my mouth. Maybe.