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

the decision to go forward

I remember the semester that I decided I wanted to go to medical school. I was an engineering major, and the thought kept coming again and again to study medicine. It was an attractive idea, and had always been since the time I was a 5 year old kid (until the interest in engineering sidetracked me during junior year of high school). One of the engineering courses that I had recently taken was ergonomics, designing machines and interfaces to fit the human body and psychology, and it was an enjoyable course. But the idea that came to me over and over again was, wouldn't it be much more interesting and fun to actually study the human body instead?

And so for weeks, the idea turned over and over in my head. There were many thoughts that were of a discouraging nature, "You're not smart enough." "It's too late. You've already declared your major as engineering." "The competition to get into medical school is so high." And on and on. But through serendipity, there was a day long course held on campus about applying to medical school giving advice to students who were considering becoming physicians. While attending, I met another student who was very optimistic and encouraging. We discussed our interests in medical school and found in each other positive camaraderie. The course gave me a starting point of what to expect in the application process, and meeting the other student gave me hope. Also, by good fortune, I found a book in the bookstore that really cemented the idea that there was a chance that someone like me could be accepted into medical school. It talked about strategies for applying and gave useful bits of information regarding pre-med requirements and even had sample application essays. Probably one of the most useful aspects of the book were the examples of several students who had made it into medical school under various situations. I carried that book everywhere, and highlighted sentences that gave me inspiration, and read it over and over.

When I look back, it seems so logical and easy, as if step by step, each decision led to another decision, and each action led to another action, all culminating into the final logical conclusion of being accepted and matriculating into medical school. But, when I dig a little deeper, it was actually pretty scary. There was no real guarantee that I would be accepted after taking another year to fulfill the med school prerequisites and another year after that to complete the application process. There was no guarantee of doing well in the pre-med courses or MCAT examination to garner any interviews. There was no guarantee that all of this time spent studying and applying would lead any closer to becoming a doctor. Sure, the engineering degree was a possible "back-up". But, it wasn't a true viable option because what I really desired was to become a doctor and nothing less. However, once that decision was made, although in my heart it was right, it definitely felt like stepping into a huge black hole. There was no way to see ahead, no way to have sure footing, no way to know that the dreams could be fulfilled. There were no guarantees whatsoever. It was terrifying at times, especially the not knowing. But, it was also exciting because the classes were enjoyable and interesting, and leading me to my dreams!

Some of the hardest times were when I knew what needed to be done, but fear and worry momentarily stopped me from moving forward. It reminds me of the first (and last!) time I ever went indoor rock wall climbing. I'm scared of heights, but tried it anyway, and happy to say I made it to the top! One of the significant keys of that success was the instructor, and what he had said. There was a point where I was three-quarters of the way up the wall. The top of the wall was in sight, and possible to attain. The ground was a long way down though, and also very easy to attain in one small slip. My friends called to me, "Don't look down!" I was scared. Frozen. There was no definite new foothold or hand hold, and I was stuck. The instructor yelled to me, "Step up! Just step up!" And through the calm authoritative confidence in his voice, I was able to realize that he was right, and all I had to do at that point was take the one leg that was bent and positioned on a foothold, and put my weight on it and step up higher. Using his advice and my friends' advice, the climb to the top was successfully accomplished.

And so it was also that way in applying to med school. Times where ruminating over the unknown future, the possibility for failure or rejection, etc etc left me frozen and paralyzed. But then something or someone or even myself would analogously yell, "Just step up!" and it would be enough to help me take the next action, fill out the form, keep studying, request the recommendation, etc. I'm very grateful to the people who knowingly or unknowingly did this because applying to medical school was a daunting task, at least for me. And it seemed like a huge risk because it was a big dream to pursue. So, what I would like to share with those of you that are pursuing a dream is this: if you run into a snag, or start to get anxious, take a deep breath, and take a step forward, even if it is a little one. Make that phone call, fill out that section of the application, inquire about that class.. You might feel as though you are in a dark room because you can't see necessarily where it will lead, and you may question what use is it to make even the tiniest of steps forward, but be persistent. Soon those little steps will add up and lead you into the light of day where you can reach your goals and dreams. And then when you look back it will seem to you that everything had a logical step and a reason, and then you will be encouragement to others on their path to their dreams.



Please feel free to share any stories you might have of accomplishing "impossible" dreams.

OMNIA VINCIT AMOR

amara

© 2010 amara/aag musings of a trauma rad