What This Med Student Believes Is Either Totally Naive or Incredibly Possible

A man who has struggled for years with alcohol addiction calls 911 pleading for help. He’s admitted to the emergency department, rehydrated, and monitored during an intense period of acute alcohol withdrawal that brings on agitation, hallucinations, suicide attempts, and violence against staff.

A med student meets this man—let’s call him John—after he’s been through the worst of the withdrawal. John is now exhausted and reluctant to talk, but he’s compliant with exams and treatment. He even warms up to the med student. She gets to know details about his life, like his hopes, fears, and that he has a strong family support network and a deep desire to recover.

Now, this is by no means the first time John has said he’s ready to quit drinking, and it’s not the first time he’s been admitted to the ED. But through her interactions with him, the med student senses that something’s different with this patient—that this time he might make it.

90% of alcoholics relapse, she knows, but she wonders, “what if John is part of that small 10 percent? What if the next one, or five, or 10 alcoholics that show up to our ED happen to be the exceptions?”

Med student Cordelia Ross had this exact thought about a patient with a similar story. In a post for the University of Vermont College of Medicine blog, she describes the incredible rapport she built with a patient she calls John, and how she believed that maybe this time John would recover.

Despite Cordelia's belief and excitement, her resident assured her that John would end up back in their ED all over again, and that it would break her heart. She knew another relapse was possible, but something else that struck her heart was how experience had robbed her otherwise compassionate resident of hope.

Just as alcoholics are prone to relapse, care professionals are prone to burnout. They’re busy, they’re stressed, and they often see dispiriting outcomes unfolding again and again. This “propels a vicious cycle,” Cordelia writes, as “the more burned out you are, the harder you become, the less you can connect with patients, the less rewarding those patient interactions become, the more you burn out.”

But Cordelia still has hope—for this patient, for this resident, and for her future in medicine. “There must be some way that we can put our biases aside, trust our patients, and encourage them to do the right thing,” she writes. “At least that’s what the naïve med student in me wants to believe.”

What do you believe?