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Navigating life stories and medical decisions

As a physician, I am given both the gift and the burden of another’s most intimate moments or even their indiscretions. There is a cloak of invisibility that wraps around a patient and me when behind a closed door. Almost as if the concept of guilt, innocence, opportunity, loss, life, and death are all present together with us in a room, while the rest of the world goes on outside. Whether in the trauma bay, the clinic office, the ICU room, or the OR, there is a moment in time when there is an understanding that what you tell me, and what you ask of me, is yours alone.

As an anesthesiologist and a critical care physician with a special interest in high-risk obstetrics, I have found myself at the bedside of humans from all walks of life who are at a crossroads. From routine surgery to the end of a life, or the beginning of another, I have witnessed countless stories, miracles, and tragedies. But the relationship I have with each individual patient remains the same: singular and unwavering. The intimacy of our relationship is there to protect your autonomy and to allow me the ability to practice medicine and provide care in the best way possible based on your story.

Each story carries its own weight – the weight of the past, the present, and the future. A story made up of circumstances both within and outside of ourselves. A series of truths that are true for you as an individual, and to which you alone are tasked with carrying. Yet, I am given the gift of having access to your truths, to the reality from which you experience life, and the reason you sit, stand, lay, or sleep in front of me. I am honored to carry those burdens with you because it’s between us.

It being what brought you here and where you are going. How you will navigate the present situation and what you wish to be a part of your future self. Your family, your friends, and the community at large have influence and bearing, but the future is yours alone. And I am allowed time in your life to help you make the best decision for you, even when it is a decision that is not one you ever thought or ever imagined making.

I understand that there are legal, judicial, and ethical limitations to the decision you make, but regardless of the specific parameters around your decision and your choice, it remains yours. I may not even agree with your decision, and in that case, I may recuse myself from your care, but it is not my right or my responsibility to pass judgment or inhibit your ability as an individual to have control over and for your own body. I am a supporting figure. You are the focus. What happens within the body that you yourself direct is not something that I can interfere with, even if what you choose to do could hasten a catastrophic outcome. I cannot force you to amputate a limb, take life-sustaining or preserving treatment, accept blood products, or even life-saving interventions unless you permit me to. That is your right. And it is also your right to determine if and when you carry a fetus and in what circumstances you may decide you cannot or will not continue a pregnancy.

I, too, may advise you that continuing a pregnancy could potentially harm or end your life. And if you decide that you will continue the pregnancy, then my job is to do all I can to support your decision and do everything in my power and my abilities to maintain your health and even your life as that is your right. And you have allowed me the opportunity to guide you in this decision and support you along the way, regardless of what the outcome may be. And for that, I am grateful and humbled for the gift you have provided me.

But we are not free from outside influence or control from those who feel that the decision between us is not sacred. Those who think that the decision to continue or end a pregnancy is not as much your right as the right to refuse life-saving interventions. The problem is that these same people write laws and enforce those that are already standing in a way that assumes that everyone’s story is not unique or built on a history that we as another cannot embody because it is not ours. We are left with laws and regulations that inhibit my ability to be your guide through impossible decisions. They may even threaten my own autonomy and freedom if I dare to offer you assistance in making a decision that is yours alone. They rip apart our relationship and our trust and replace it with judgment and an assumption of superiority while ignorant of the stories I hear in the confines of our relationship.

Our relationship is sacred. It has carried a weight that transcends cultures, centuries, and circumstances. It is meant to be a place of mutual respect and confidentiality. A place of naked vulnerability that is protected from view of the public by the nature of my profession. This relationship is essential for you to have the confidence to know that I will support you in the decisions you make for your life as an individual. A decision that affects you alone. A decision that is not inclusive of another’s opinions, religion, philosophy, or moral standards. A medical decision that is made by you and afforded you as an autonomous individual who can decide what you will and will not do with the body that you possess. From now until the end of my career, it’s between us.

Nicole M. King is an anesthesiologist and intensivist.

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