Editor’s note: All names and identifying details have been changed to protect patient privacy.
I was starting my surgery rotation, the second rotation of my third year, on the colorectal service. It was my first 24-hour on-call shift, which meant that my team would be responsible for multiple surgical services overnight. I anticipated this shift with mixed emotions having just watched a fellow medical student leave her overnight shift. By that, I mean she stumbled out of her overnight shift. While I feared the inevitable caffeine crash and my reflection in the mirror the next morning, I nevertheless looked forward to experiencing the balancing act of managing numerous services, which included the gastrointestinal surgical oncology service.
In the middle of the night, the resident received a page from a nurse requesting that the team counsel Bob, a patient with pancreatic cancer, about his future appointments because he had many questions. The resident was busy juggling several different patient concerns, so he directed me to Bob’s room to be the first line of defense.
When I entered the room, Bob was preparing to get out of bed to use the restroom. He was so frail and thin in his hospital gown. The mere sight of him reminded me of a small child wearing his father’s T-shirt and swimming in cloth. As the nurse prepared syringes for his intravenous therapy on the other side of the room, I held out my hand to help Bob. He adamantly refused, asserting that he could do it himself. On taking his first step, his legs buckled, gravity pulling on his upper body until he toppled into my arms.
As he struggled to rebalance himself, he tearfully moaned, “What’s the point? I’ll be dead in a month anyway.”
With his body quivering in my arms, I froze. Moments passed before I thought to reposition him in the bed until a nurse could aid me in supporting him as he walked across the room. I remained mute and paralyzed from the sudden epiphany that there was nothing I could say or do to erase the inevitable truth that Bob was dying. As more nurses and the resident entered the room, I quietly excused myself, rushed to the staff restroom and burst into tears as soon as the door shut behind me.
Like a towering wave upon a beach, the weight of all of my emotions crashed over me, and questions rushed through my head.
What’s the point of what? Of medicine?
What even is my role if not to cure disease?
What kept me from saying “I understand” or “I’m sorry, sir” as I stood there motionless?
For days, these questions plagued me making me feel powerless and profoundly disappointed in myself for not having been present for Bob when he needed someone most. When I thought of Bob, images of my own family flashed into my mind. When I imagined Bob trembling on the edge of his bed, I remembered my dad who was paralyzed from cancerous lesions in his spinal cord attempting to swing his legs over the intensive care unit bed to walk during the hours before he passed away.
Memories of my mom and brother listening to him and comforting him reawakened the sense of sadness and helplessness that I felt in that moment which was the same as I had just felt with Bob. I thought of how lucky my mom, brother and I were to have been with my dad. I thought of how lucky my dad was to have had us. Bob had no one. I was ashamed that, in leaving Bob’s room, I had put my emotions first as if they were more important than his, and that I had left him alone when he had no family of his own.
That whole week, I tossed and turned as I lay in bed wondering whether I should go back to him. To apologize? To show that I cared without pitying him? To assure him that no prognosis is definitive? Ultimately, I never returned to see Bob; my rationale was that he wasn’t on my service after my on-call day and that nothing I could do would help him.
Now that time has passed, I am able to reflect back on my encounter with this vulnerable patient. I recognize that the point of medicine really is not to become the arbiter of life and death; it’s about being present for patients in their times of need. If we lived in a world with time travel, I would have sat on the bed next to Bob while the resident and nurses entered the room. I would have remained silent for as long as he needed to mourn and grieve.
I realized that the uncomfortable conversations will likely never become more comfortable for me and that I may never convey how much I care with a simple “I’m sorry.” The act of listening has more power than any words can communicate. In times of distress, there is always a reason to revisit the patient, and there is always a way to help.
When necessary, relinquishing control over patients’ health to be a better provider seems incredibly difficult for all of us to do, either because of our own past experiences, our fear of failure or our preferred ignorance. As student doctors, our role is not to simply cure disease; it is to alleviate suffering in whatever seemingly small ways our patients may need. It is with this mindset that I will be approaching not only the rest of my third year, but also the rest of my career.