The Road to Aequanimitas

As a young doctor, I didn’t understand that I could enter my patients’ lives to the degree that I do now, and that doing so would make me a better physician. After some particularly challenging experiences of death and loss early on, I read Ignatius of Loyola’s “Spiritual Exercises,” written in the 1500s, in which he teaches about our frequent failure as humans to attain fullness in relationships. Pulling back in most circumstances at the bedside in my early years, I now understand the impact that the desire to protect my own heart had on depriving my patients of the true covenant relationship they deserve from me as their doctor.   

Don’t get me wrong, I had always cared for my patients and wanted to do my best for them as their doctor, but I was treating them as inanimate objects, in what philosopher Martin Buber describes as an “I-it” relationship. I’d collected data and analyzed and classified them, seeing my patients as a set of organs to fix and a list of problems to solve. I’d read and recommended Samuel Shem’s novel “The House of God,” about an overworked intern learning the ropes in a hospital. Shem’s narrator, while hilariously entertaining, depersonalized patients, using disparaging terms such as Gomer (Get Out of My Emergency Room). I saw now that I, too, had shown callous disregard for some of my patients. I’d thought it innocuous to use “Gallbladder in Room 557” to consolidate both person and diagnosis, without digging any deeper. I wasn’t seeing my patients as fully human. Did they know?   

Now, looking back, I suspect many did. As a medical student, and during my training, I was often taught to keep a professional sense of reserve and mental distance from patients, that getting to know them too well would backfire and cause me stress if they died. When I graduated from Tulane Medical School in 1989, my mom gave me a leatherbound copy of Dr. William Osler’s “Aequanimitas,” his famous address delivered to new doctors at the Pennsylvania School of Medicine exactly one hundred years earlier. Osler’s words, advice derived from Aristotle, became a touchstone for me: “Deep voice, slow speech, tight compartments, with the mind directed intensely on the subject at hand.” I carried the quotation with me every day on a handwritten card in the pocket of my white coat, as if doing so would allow me to connect directly to them both. I’d used equanimity many times as a tool to pause, pull back, and process. To maintain balance and composure.   

But what happens when the asset Osler was speaking of, Aequanimitas, is overused? It becomes a liability for me and my patients.   

In my life, I finally opened up with my patient Marcus Cobb (permission to share his name and story), who’d suffered from heart disease since he was a baby. With Marcus, I dove completely into our relationship in a way that Martin Buber refers to as an “I-Thou” encounter, meeting him fully within his life as a heart-lung transplant recipient. I’d been reluctant to have such depth in my relationships with patients earlier, but he and his wife Danita persisted in developing our relationship. Taking me by the hand. And I was so glad that they did.   

Marcus’s heart-lung transplantation became the gift he’d always dreamed of, not only giving him more time with Danita and his children, but also the opportunity to embrace activities he’d only imagined in the past. Going for long sunset hikes in the Blue Ridge Mountains, even parachuting from helicopters. He grabbed life with both hands. But during our monthly and, later, quarterly clinic visits, I noted with a smile that the activities that seemed to give him the most pleasure in his new life were the smaller things, such as simply throwing a football with his kids.   

As we knew would happen, all good things fade, and this is most certainly true for the tenure of organs at the whim of a stubborn immune system. Several years later, I was about to give a lecture to a few hundred doctors at a medical conference when my phone rang. It was Danita: “Marcus is dying. He’s asking for you.” Without hesitation, I apologized to the meeting organizers and rushed to the airport to catch a plane home. It was a particularly clear day, and from my window seat, I watched the canyons and lakes pass beneath us, praying all the while that I’d get there in time.   

In the cab from the Nashville airport, on my way to Vanderbilt, I called Danita to ask for the room number. “It’s number five on the eighth floor . . . but hurry.” At the hospital, I sped to the elevators and shot out into the hallway. As I rounded the corner, through an open door I saw a crowd. I slipped into a nearly complete circle of about seven others. They’d been waiting for me. I put my hand on Marcus’s shoulder, looked him in the eyes, and talked directly to him. He was the only person in the world who mattered at that moment. It had become second nature to me by then. He looked up at me and I whispered, “Thank you,” sauntering out of life.  

Dr. Wes Ely is the author of “Every Deep-Drawn Breath,” a work of narrative nonfiction from which 100% net proceeds are donated into an endowment for COVID survivors and their families. He can be found on Twitter and TikTok @WesElyMD.