March 18

What Is Ours to Carry?

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Inner Practice of Medicine
Wendy Lau 
Walking Mountains Publishing, 2023
Softcover, 162 p.
ISBN: 979-8988547129
MSRP: $12.99 USD
Also available: eBook (Kindle)

Reviewed by Frank Brennan, MD

As clinicians we are blessed to meet patients. It means we are not solely submerged in our own thoughts. We need to speak to and engage with another human. It is in our hands as to how superficial or deep this encounter may be. We may chose, or be trained to chose, to be protocol-driven, even mechanical. Equally, we may be curious, vigilant, and open to see the human being behind the disease. We may reflect on their suffering. Midway through Inner Practice of Medicine, Wendy Lau, an emergency physician, describes such a revelation. Upon meeting a young patient, she recalls: “Something about his desperation touched me so deeply that it jolted me out of my emergency mode and I saw a fellow human being suffering… I realized it was more important to bear full witness to this man’s pain than to come up with any kind of solution or a quick excuse to get out of this encounter.”

Lau’s book takes as its premise the challenges of the modern practice of medicine. Physicians who enter medical school with high idealism may be confronted, upon graduation and in the years thereafter, with overwork, large numbers of patients, unsympathetic senior colleagues, a corporate ethos in the US, and being unprepared for the fact that their patients may die. She describes this process as a “loss of innocence.” 

When this background is complicated by the foreground of the COVID-19 pandemic, doctors and all clinicians can be traumatized. Acknowledging these facts, Lau seeks a way through. Combining her experience in emergency medicine with her training as a Zen Buddhist priest, teacher of meditation, and chaplain, Lau examines the reasons physicians respond to stresses in the way they do and completely reconfigures the patient encounter. From a disengagement encouraged by colleagues or by the medical system itself, she explains how to re-capture and retain the humanity of patient encounters through an openness to emotions and a self- reminder on precisely why you chose medicine in the first place.

Correctly, Lau identifies that one of the greatest challenges felt by modern physicians is the death of a patient. She describes the complexity of physician reactions, including a rumination on what more could have been done, even a sense of professional failure. Setting aside medical error, Lau concludes that with most deaths, physicians could not have done more and, echoing the Serenity prayer, states: “What we need in medicine is a way to look within, acknowledge what is ours to carry, what is out of our hands, and to be able to process the difference.” 

This is a fine, thoughtful book that will help physicians, junior and senior alike, in navigating their personal responses to the challenges of modern medical practice.

Dr. Frank Brennan is a palliative care physician, past president of the Australian and New Zealand Society of Palliative Medicine, a senior lecturer in the Faculty of Medicine, University of New South Wales, and a lawyer. 


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