Contributing Writer
University of Southern California Keck School of Medicine
Erica Patel is a third year medical student at the University of Southern California Keck School of Medicine. She studied Narrative Studies at USC as an undergrad, and loves the intersection of stories and medicine. Erica is a board member and medical director of Wema Children Center Inc, a non-profit she started that provides education, housing, and medical care to orphaned and low-income children in rural Kenya. She plans on pursuing a primary care field and working in developing countries while writing about her experiences to increase awareness.
One after the other, day after day it seems, I find myself in a room where the resident is breaking the news of terminal cancer to my patients and I feel an overwhelming sadness belied by numbness. It has only been a week and a half on internal medicine and we have already diagnosed three unsuspecting patients with cancer.
Although there is really never a right time to die or even witness death, it is important to acknowledge that death is a reality, and one to which all health care practitioners will be subjected at some point in time. For that reason, I raise the question: is there an appropriate time to lose a patient? From my perspective the answer is yes, and for good reason.
She had survived an avalanche and was now lying face down in the debris. Longstanding ischemic brain disease had triggered a seizure. The seizure stunned the heart causing a cardiomyopathy. The cardiomyopathy, unfortunately, exacerbated her chronic obstructive pulmonary disease (COPD). As her oxygen saturation dropped, she was intubated and mechanically ventilated. She was now agitated, restrained and delirious.
“You need to come in to the E.D. ASAP.” A new patient was admitted at 2 a.m. and requested for a crisis counselor. Back in 2009 when I was volunteering in New York City, unlike with cases of sexual assault, survivors of domestic violence had to specifically request for the presence of an advocate. This woman, I’ll call her Sadie, had already taken the first courageous step to seek help.
“The baby’s out,” shouts one of the labor & delivery residents as her hands firmly grab and pull the baby’s shoulders with the mother’s final push. A nurse holding the mother’s leg during the delivery walks over to the pediatric team and whispers, “cleft lip,” as if the baby had committed a crime. Instantly, we fall silent.
“To most physicians my illness is a routine incident in their rounds, while for me it’s the crisis of my life. I would feel better if I had a doctor who at least perceived this incongruity.” –Anatole Broyard. When I first encountered Broyard’s quote, it resonated with me on a personal level, as I was reminded of an incident that occurred on my surgical rotation.
She was a petite, otherwise well-appearing woman, apprehensively sitting at the edge of the examination table. Hoping to mask my nervousness about this first, intimate patient encounter, I inquired about the reason for her visit. She told me that she was here to discuss a hysterectomy. She shakily explained her two-year history of heavy, painful menstrual bleeding. She hoped that the hysterectomy would be her saving grace. The insistence on this procedure made me suspicious of stirring waters beneath calm surfaces, so I probed further.
Today was my most challenging day of clinical work yet, but it had nothing to do with charting, the number of patients, or the attending on shift. Instead, today was about experiencing humanity and embracing the emotion of caring for others in their most trying moments. As a third-year medical student on my second rotation, I have not lost a patient, seen a code, or experienced serious trauma. I have not had to cope with loss yet. I recognize my innocence and realize that it must change eventually. That process began today.
Last Saturday evening I was on the admitting team in Orange County. We got a call about a hematology/oncology admission that we would later pass off to another team in the morning. We were told “fever with an ANC <500.” That admit, was Ronaldo, a young male with acute lymphocytic leukemia.
It is one thing to be a doctor and another to be a patient. It is a radically different thing to be a medical student paired by your medical school to a physician who is your “patient-partner.” Sounds like a word salad, but that is where I found myself as a first-year medical student at The Geisel School of Medicine of Dartmouth a few weeks after moving to New Hampshire, weeks before I would receive my white coat, months before I would have any clear idea of what the medical world is really like.
I arrived at the neuro ICU at 5:30 a.m. to read up on my new patient before rounds. The resident on duty the day before had accepted a transfer at 7:00 p.m. and documented the following in his note: Mr. X is a 72-year-old male with a past medical history of severe bilateral carotid artery stenosis who had a devastating right MCA ischemic stroke at home this morning, confirmed by CT at an outlying hospital.
“He’s had enough, you don’t want to put him through any more.” Dr. Acharya’s soft jowls folded into a cool smile, as though he hadn’t thought of acids unfiltered by failing kidneys. I dug my fingernails into my palms. Glancing at the bed where my grandfather lay, I watched his bare, gray skin grip the scar that split his ribcage in two. Behind his parted eyelids were unfocused blue eyes, glazed with whitish film. He hardly knew we were there — hovering over him — deciding whether he would have a chance to live and suffer, or whether he would suffer and die.
Contributing Writer
Yale School of Medicine
Bridging the divide between the biomedical and social sciences, Jes enjoys her unique position as an anthropology MD-PhD student to advocate for social justice at Yale. Apart from academics and service, Jes relishes the chance to overfeed guests in the style of her Italian-Chilean upbringing and to dance until she bursts into laughter. Follow her on Twitter @jes_minor
