It didn’t take long to meet our patients, many of whom exhibited little interest in exchanging pleasantries. There was an elderly man suffering from late-stage Parkinson’s dementia. There was a patient with schizophrenia experiencing a COPD exacerbation. Then, there was Mrs. G, who was admitted for immune thrombocytopenia. She was a retired teacher who spent her time volunteering at her church and caring for family members. She smiled warmly when I introduced myself as, “Joshua the Medical Student” and announced that she would take good care of me during her stay.
Nothing is quite as strange as the first day of your surgery clerkship. It isn’t just the shock of seeing a living human intentionally cut-open or the unforgettable smell of cautery for the first time — even just getting into the operating room can be an obstacle.
My foray into the wilds of Alaska was part a journey that my classmates and I call “the Safari.” While no African wildlife are spotted on the trip, bears and moose are plentiful, and the journey traverses over a quarter of the United States landmass, from four-room clinics serving towns of a few hundred people to the massive edifices of a level one trauma center and tertiary care university hospital serving five states. For those unfamiliar with the program, the University of Washington is the only allopathic medical school in the “WWAMI” region, comprising of Washington, Wyoming, Alaska, Montana, and Idaho; the school has clinical sites and regional teaching campuses in each of these states. Come third year, students can request rotations in the multiple hospitals in Seattle, or rotate at the regional sites.
It was early in third year and Ms. G was my only patient. I visited her every morning and evening and sometimes in-between. While our discussions had little to do with receptors and pumps, Ms. G taught me some of the most enduring lessons of that year.
He is not the first person to tell me that he’d rather be dead than alive. He is the first person to do so, so publicly. We sit side-by-side in orange, plastic chairs in a recessed, rectangular room awkwardly crammed in the middle of the unit. There is a nurse behind me taking the blood pressure of another man while he climbs stairs, part of the rehabilitation process for individuals receiving Ventricular Assist Devices in this hospital. Next to the nurses’ station stands a physical therapist, whom I’ve been tailing after like a cheerful retriever as part of our medical school’s homogenized introduction to hospital care.
In my third year of medical school, I was taking care of an elderly patient who had been in and out of the hospital multiple times in one month. Upon his third admission, my exasperated attending threw up his hands and said, “Who am I, Sisyphus?” I understood how he felt. Like the mythological Greek king rolling his boulder up the hill — only to have it roll back down again, ad infinitum — no matter what we did to manage this patient, he always returned to the hospital sicker than before.
On the first day of my psychiatry rotation I was anxious, and like most students I worried. I worried I would not have anything to say and I worried I would say too much. I worried I would say the wrong thing at the wrong time and I worried that my words would be more consequential than I ever intended them to be. I worried about my worry.
As a fourth-year medical student, I enjoy introducing myself to patients as the “extra eyes and ears of the team, so feel free to tell me anything you forgot or would like to address, even if you think it’s irrelevant or burdensome. I will be your advocate.” As I establish rapport with them, the walls come down, and they often provide important information that helps my team provide the best care for them.
In medical school nowadays, there is a heavy emphasis on perfecting a physician’s demeanor when interacting with patients. Classes on essential patient care focus upon the social constructs of medicine, allowing permeable medical minds to ponder over various patient-care scenarios and determine the perfect method of one’s bedside manner. I used to believe such classes were ludicrous.
Not long ago, I was on duty in the emergency department, sewing up a kid’s lacerated hand. He was ten years old and terrified. I had to make all kinds of promises to numb him up before starting. As I cajoled him, I had the strangest sense of déjà vu. I realized that I had lived through the same experience myself — as a young boy sitting in my kitchen with a torn up hand, having careened on roller-skates into a pile of rocks. Only the doctor had been my father, and he had coaxed and pleaded with me just like I was doing now.
White gloves on black skin. The fingers of my gloved hands still interlaced, still resting tensely over her sternum. Elbows still locked. Frozen in the position endlessly refined during CPR training. It turns out that blood flow is important for catheter angiography, which presents a challenge if your patient has no heartbeat. Has not had a heartbeat for 45 minutes.
As physicians, it is our responsibility to understand these serious implications and to help these patients live as fully as possible. A patient is not just his or her numbers — their vitals or their lab values. A patient is not just an MRI reading or a CT scan finding. Every individual has a mind, and we must take into account mental health when treating these patients because if left untreated, they can have dire consequences. More importantly as people — as humans of society — we must not stigmatize these illnesses.