I had developed a strong friendship with Ms. D during the rotation, and her passing became one of the first confrontations with grief that I encountered as a rising medical student.
If there is one thing I have learned, it is that what we, the medical providers, think is important may not necessarily be the priority of the patient. We want to know: why are your sugars uncontrolled? How is your diet? Have you been able to take your metformin? However, for the patient, these things are often trivial. The patient wants to know: how will I be able to afford these medications with my part-time job? How am I expected to see a specialist without insurance? Should I be going outside to exercise, or will I contract coronavirus?
Having a family, for some of us, is also non-negotiable. We want to be moms, and we have the right to pursue more than just medicine. So let us flip the script in our mind. Our mindset should not be a question: “Can I have a baby during my training?” Instead, let us decide, “I will have a baby during my training, and this is how.” Own it. Do not apologize for it.
She was a woman in her early twenties accompanied by her husband. She was a first-time expecting mother at 19 weeks gestation with twins. They had received regular prenatal care and had been doing everything as the doctor had instructed to ensure a healthy pregnancy. She made this appointment because she felt something was off, her motherly instincts already keen.
I have become, in these last six months, a twisty little ouroboros. I eat my tail because it’s all I know, and I savor my pain and confusion. I am always full and always empty and a little twitchy from all the coffee. We are one of the few medical schools in the country to push ahead early with in-person rotations during the pandemic.
Patient 15 was a fit 38-year-old female with a past medical history of dilated cardiomyopathy who presented for follow-up on her most recent echocardiogram results. Flipping through the past notes, prior echos, family histories, I was captivated. A previous echo revealed an ejection fraction of about 50% — her heart was already revealing its impending fragility. The most recent echo, just five months later, revealed an ejection fraction of 20% — her heart was failing!
In the extremely efficient and fast-paced environment of health care, the emotional needs of patients and their families may become secondary to their medical treatment plan. But emotional stressors may be directly associated with poor outcomes in regards to the healing process and overall quality of life. Thus, these needs may be addressed by face-to-face communication that allows for better patient education. Such investment of time is most rewarding when both the patient and family members have the opportunity to explain their fears and worries regarding treatment.
In the neuro intensive care unit, I took part in a meeting with my team to update a family on the status of their loved one. It was my first time in this type of meeting, especially for a patient that I was directly involved in caring for. To our team of medical professionals, he is our 51-year-old male patient with a 45-pack-year smoking history, but to his family, he’s a son, a husband and a father.
I actually don’t remember his name; he wasn’t my patient. I just saw him during rounds every day during my internal medicine clerkship. He was in his late-80s, and he was very ill. He had a long history of COPD, most likely attributed to his even longer history of smoking. He had been admitted to our service for a severe respiratory infection a few days prior to me starting the rotation. This was my last rotation of my 3rd year, and I walked in thinking I had seen enough COPD patients to know exactly what to expect.
You were my first patient on my first inpatient rotation as a third-year medical student, which meant that I had absolutely no idea what was going on. I was mostly concerned with trying not to faint during presentations on morning rounds. I stared at your bowl of Cheerios, the cereal beginning to turn the skim milk a pale yellow. Your brow furrowed in annoyance behind your thick glasses.
Mr. K had been admitted with dehydration and malnutrition secondary to diarrhea in the setting of HIV. During his stay, he developed refeeding syndrome. When the resulting electrolyte imbalances paved the way for cardiac arrhythmias, he coded twice in the ICU. The care team managed to bring him back each time, but not without consequence; the brutality of numerous cycles of CPR left him with multiple rib fractures, inflicting him with sharp pain every breath.
You don’t have to sit in silence and painfully nod along with an attending’s racist, misogynistic lectures because you’re their medical student. You don’t need to pick the skin off your cuticles to stop yourself from replying. You don’t need to learn how to hide your grimaces behind your mask because you know you’ll have to listen to them attack your identity for the next several weeks.