What happens when you identify too much with a patient?

The Rules of the Doctor’s Heart
By SIDDHARTHA MUKHERJEE

Every medical case, to paraphrase the writer Viet Thanh Nguyen, is lived twice: once in the wards and once in memory. Some of what follows is still intensely vivid, as if it were shot in high-def video. Other parts are blurry — in part because I must have subconsciously deleted or altered the memories. I was 33 then and a senior resident at a hospital in Boston. I had been assigned to the Cardiac Care Unit, a quasi I.C.U. where some of the most acutely ill patients were hospitalized.

In mid-September — it had been a moody, rain-drenched month, as I recall — I admitted a 52-year-old man to the unit. I’ll call him by the first letter of his given name, M. As medical interns, we were forewarned by the senior residents not to identify too closely with patients. “A weeping doctor is a useless doctor,” a senior once told me. Or: “You cannot do an eye exam if your own eyes are clouded.” But M.’s case made it particularly hard. He was a doctor and a scientist — an M.D., a Ph.D., like me. He must have been about 15 years ahead of me in his schooling; I could imagine him returning to my class in med school to teach us “Patient-Doctor,” in which students are taught how to deal with real-life patients. He’d trained as a medical resident and then as a fellow in cardiology at another hospital across town. He was now an assistant professor — it seemed like such a victory to have that title — and ran a small laboratory. I knew a student who once worked with him. Six degrees of separation? There was barely one.

Earlier that year, in March or April, M. became short of breath in the middle of his run. (Was his running route the same as mine? Across the Longfellow Bridge at Mass General, looping around the river and then back again by Storrow Drive?) His legs turned cold and blue. He had dizzy spells and lost words in midsentence. He saw a cardiologist — presumably one of his own colleagues — who diagnosed heart failure. A series of scans must have revealed a sluggish heart. In place of the regular, intentional motion — jellyfish pulsing in a tank — there was an eerie wobbliness, just jelly. A biopsy was performed, and the diagnosis was amyloidosis, a mysterious condition in which misfolded proteins begin to be deposited in the organs of the body. Sometimes the proteins come from cancer cells; sometimes from poorly understood sources. The deposits choke the organs: heart, liver, blood vessels, kidneys. “And then, bit by bit by bit, I was all pro-te-in,” he said dryly, paraphrasing the Tin Man in Oz. We laughed.

M. needed a new heart. I’m writing this casually, as if you go to the used-heart salesman on Long Island and pick one up on a three-year lease. Hearts are notoriously hard to find; someone has to die for you to get one. About 3,000 hearts are available in the United States every year. Many come from youngish men and women who’ve had accidents or drowned, leaving them in a peculiar limbo — brain-dead but heart-alive. But there are never enough: At any given moment, about 4,000 patients are waiting for a heart. Many of them will never find one... (continues)