Four Lessons
By: Anonymous
Four lessons from four patients during a month-long inpatient rotation:
An 86-year-old man is admitted for a CHF exacerbation; on his last echo he has an EF of 10-15%. He has a 180-pack-year smoking history. Rounding on him every day, you get to see how poorly a person with little remaining heart function looks, even with daily clinical improvement. Because of him, the sound of crackles will now be unmistakable to you, and you were able to practice the abdominal exam more than you ever have. He tells the entire team “You’re a good kid” every day, a compliment you find extremely moving. You make a mental note: “Strive for this sort of relationship with every patient you ever take care of”, a goal you are sure you will be very grateful to him for in the future. You treat his episode and he gets discharged, but his cardiologist tells you he probably has 6 months remaining and states, “Why did he not ever develop lung cancer? There must be something about him genetically in regards to smoking which should be studied.”
Lesson one – sometimes patients break the “rules”, and sometimes patients do more for you than you can ever do for them, even as their caregiver.
An 83 year old man with a recent left MCA stroke gets admitted with a fever and altered mental status. He was found to be micro-aspirating on a swallow evaluation, developing an aspiration pneumonia. His recent stroke has drastically changed his quality of life; he now cannot move his RUE/RLE, has a right sided facial droop, has difficulty swallowing, and can only whisper. During admission he looks sad regarding his new disabilities and his current state. You hear him whisper “Just let me die, just kill me” multiple times, which in turn saddens you in a way you have not yet experienced. You and your intern continually mention how depressed he seems. During a geriatrics lecture at noon conference, you hear that left-sided strokes in the elderly are associated with depression, which immediately makes you think of your patient, and realize this is something that you will now remember forever.
Lesson two – you can read and study all you want, but NOTHING cements information into your memory better than being able to correlate something you study with something you have seen in real life.
A woman in her 90’s presents with fever and altered mental status. She is found to have malodorous and severely necrotic leg ulcers. She is nearly deaf, so you literally have to shout at her to communicate. She seems confused and is rambling about many things including how thirsty she is. She keeps fumbling around with the cup of water you bring her. You become quite fond of her high-pitched, crackly “old lady” voice. Her wounds are debrided. You see her on rounds and shout “hello!” and she exclaims “Can you please cut these pancakes, I cannot eat food this big!”. You proceed to slice away. Cutting her food into smaller pieces becomes a daily routine. One morning you miss her as she went to the O.R. for further debridement. You see her on afternoon rounds with the team and notice she is about to eat her lunch, untouched and unsliced. Bothered, you stay behind as the team leaves, furiously trying to cut away so that they don’t notice your absence when rounding on the next patient, but they catch you. Members of the team praise you but you did not wish to receive any accolades whatsoever; you were doing this simply because you wanted to help – she reminded you of your grandmother. Unstirred, the attending motions, “Okay guys, let’s go, next patient”. The next morning you see her and one of the many things she rambles includes her saying, “This place is not nice at all, all you people seem to do at this hospital is push me around, push push push! I am going to tell everybody about this place!”
Lesson three – no matter how earnestly you may try to help and care for a patient, no matter the lengths you go in attempting to make them feel comfortable, there can be an immeasurable amount of variables, beyond your control, which will make the patient feel completely unsatisfied with their time at the hospital. Be prepared for this, and do not let it deter you from providing as much care as possible.
A blind woman in her 70s is admitted with delirium secondary to a UTI. She speaks zero English, but is accompanied by her daughter-in-law, who translates. You share the same religion as the patient and her family, and they come from a country in South Asia that neighbors your own ancestral homeland. You become close to them during their stay. Being brown, they think highly of your status as a medical student and naturally come to inquire about your age and marital status. When you answer, the daughter-in-law responds, in what seems a bewildered fashion, saying, “What? Not even a girlfriend? What are you doing?” Unprepared for such a forward, blunt response, you laugh and die inside at the same time.
Lesson four – I’m in my mid-20s, single, and in loads of debt; I have friends my age with jobs, getting paid, getting married, and having kids…what exactly am I doing with my life, and why must brown aunties always remind me of this question? It is a long, grueling four years, and clinical years will be completely unexplored territory. Take and learn what you can from every patient, every moment, every day.