dedication to a patient

It was my first rotation ever in the hospital as a third year med student.  First time seeing actual patients, first time interviewing and examining patients, first time being on the floors and getting used to everything and everyone, and it was a little overwhelming.

This first rotation was inpatient Internal Medicine, and she was one of the first patients I ever admitted.  She was in her 70s or 80s, but her age was probably the least memorable aspect about her.  What was most striking was her vitality, enthusiasm, and optimism.  She was in the hospital getting a work up for stroke, but ironically when I met her, she had full presence of mind, intelligence, and was very engaging in conversation.  She had that certain something that exuded a life well lived-- full of joy, no regrets, and and enjoying life in each moment.  

After performing the history and physical (H&P), we chatted.  She was very interested in me and excited to hear that I was studying to be a doctor.  She was very encouraging and expressed confidence that I would make a good one. Transitioning from the two years of lectures and labwork to seeing patients on the floors, was basically like jumping in an ice cold pool, the contrast was so great. So her enthusiasm and optimism were balms for the awkwardness and uncertainty I was feeling in this new environment.  She expressed excitement for me in this new phase of my life, as well as delight in that I was pursuing a lofty goal.  She told me that she was an archeologist and had travelled to Egypt for work.  She had been married, but did not have children.  And it was evident that she still had childlike curiosity and inquisitiveness.  It seemed to me that she lived her life pursuing what she loved, and enjoyed every minute of it.

I remember the first two days visiting her, and wondering why she was even in the hospital.  She seemed fine to me.  When stopping by to check on her during rounds, we would have lovely little chats, and it was like visiting a wise older friend.   But, then it happened.  On the third day, the intern reported to our team that this patient, my new enthusiastic friend, had been wandering the hallways overnight and had removed her gown.  After hearing the news, I visited her that day on rounds, and she was tired and friendly, but not quite as energetic.  The next day again it was reported that she had wandered the halls, and even became belligerent.  To hear this news was incomprehensible.  I made a visit to her on rounds, and upon seeing her, discovered her hair was disheveled, her gown was in disarray, and she was upset.  "Mrs. so-and-so?", I said tentatively.  She recognized me and answered in her usual self.  But after a few minutes she became very irritated and angry.  It was so shocking that I stared at her in disbelief.  How could this woman who was so sweet, intelligent and poised, now be yelling epithets and be so aggravated?  Then, as if in answer to my incredulousness, for a few seconds, my friend became lucid and with clarity and full presence of mind looked me straight in the eye, and gently said, "I am so sorry."  I began to say that it was okay, and then as if a veil suddenly slipped over her eyes she became belligerent again.  And she was gone.  Forever.

After that moment, she became increasingly confused and agitated. And unfortunately a day or two later, I was moved to a different team on a different service.  The intern on the team took over her care, and complained how difficult this patient was.  The thing is, this female intern had never known her prior to her stroke like I had, and if she had, I'm sure she would have had a greater compassion and understanding for this patient, my friend.  The intern did not have the fortune of meeting this interesting and amazing woman, and only knew her as a "problem" crazy patient, an "old" woman who wandered the halls naked and yelling.  And the huge disparity in her perception of my friend versus my perception really made me think about how often we may misjudge other people and not give them the benefit of the doubt, or make an incorrect judgment by not seeing the whole story.  How easy it is to take a quick "snapshot" of someone at a certain time and place, and pass judgment.  But yet, how difficult it is to look beneath the surface and investigate a little deeper, or give benefit of the doubt to someone who may not be acting the way we would like them to act.  I am so grateful to have had the opportunity to have met my friend and the insight that she gave to me on that first rotation of my medical career.  It's a lesson that has to be practiced and practiced and practiced and practiced, and also remembered, remembered, and remembered.  So, even though we knew each other for a few short days, her impact on my life has been quite significant. She is a reminder to look beyond the surface of things, and to be open and willing to understand. 

So, as this is my inaugural blog, I wanted to honor her by writing about her spirit and encouragement towards a young new med student.  With such a personality as hers, it seems only logical that she probably encouraged countless of people in her lifetime. 

As a med student, intern, resident, fellow and attending physician, you are witness to the gamut of happy and tragic situations that can happen to human beings.  You are privy to intimacies and responsible for the care and well being of others, and therefore, this vocation cannot be taken lightly. To be a physician is an honor and a privilege. 

I would like to thank God first and foremost, for the gift and opportunity of being able to pursue the dream of becoming a doctor; to my parents and brother for unequivocally believing in me and supporting me; to my close friends for being my confidantes and also believing and encouraging me; to my prior attendings and fellowship program directors and attendings for their vote of confidence, instruction, and enthusiasm; to the ancillary and auxiliary staff of the various hospitals who were of assistance and generous and optimistic; and last of all but certainly not least, to all the patients who teach me every day, and enable me to learn more and more in order to help others, with a special note to my friend. I give heartfelt thanks to everyone, and hope and pray to be of benefit and a channel for healing. 

Thank you for stopping by and reading.

OMNIA VINCIT AMOR

amara

© 2010 amara/aag musings of a trauma rad