It’s 1 a.m., everyone’s running on three cups of coffee / When a man stumbles through the entrance / And I could hear whispers of / It’s him, the homeless man, back in the ER again
To physicians, hospice frequently symbolizes defeat. Referring a patient to hospice care can feel like admitting that disease has defeated years of training. In medical school, we are trained that the role of the doctor is to fight the disease and find the cure.
During the team huddle I was assigned to Room 403, Bed 1. “There is a lot you can learn from this patient. You should see him.” I got the one liner and was off.
A pair of Navy socks on pale, scrawny legs — that’s what I remember about him. 0300 hours in the ED and the umpteenth “What brings you in tonight, sir?” and suddenly all the patients start to meld together.
Most of us enter medical school with a desire to affect change for our patients in meaningful and positive ways. Despite being aware of the impossibility of achieving this dream in every case, we hope to provide our patients with definitive diagnoses and successful treatment plans.
Sunrise on the psych unit. A tentative, yawning flicker, a wash of tired fluorescence, and the hallway shudders to life—or something approximating life anyway.
I met Rosa on my first rotation. My clinical year began with overnight shifts on the obstetrics and gynecology service at an affiliate hospital. My second night was halfway over when, at two in the morning, Minnie and I were summoned to the emergency department.
Medicine has passed through many shifts in paradigms throughout its development, starting from the first establishments of hospitals and medical centers in the 1800s to the human genome project in the early 2000s. Such events changed our perspective on how we study diseases.
When I enter the examining room, Mr. Jones is visibly distressed. His chest heaves as he struggles to catch his breath. I glance at his charts and make note of his chief complaint: chest pain. After a brief introduction, I fire off a barrage of well-rehearsed questions: When did the chest pain first begin? Does it radiate outwards or stay localized in one spot? Is there anything that makes the pain better or worse?
Delirium is a bread-and-butter presentation. The differential writes itself — stroke, infection, intoxication, electrolyte imbalances, shock, organ failure. The intellectual exercise this invites was practically invented for medical students, even if the final diagnosis (dehydration secondary to gastroenteritis) and its treatment (fluids) were relatively mundane.
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.
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.