As medical students and soon-to-be future physicians, we are taught to be hopeful when it comes to our patients. We smile; we comfort. We tell patients to put their trust in us because we believe we can cure them. We not only heal with our hands, but also with our words—reassuring when there is doubt, bearing a beacon of light when there is darkness. But what happens when that hope fails to illuminate, and our hands cannot heal?
When I met Mr. R during the first day of my medicine rotation, I never thought he would actually pass away during that hospital stay. I thought that I, along with the residents and attending at our well-regarded institution, could cure him—after all, he presented with a simple pneumonia. He was otherwise healthy, and his prognosis looked good.
I found out Mr. R passed away during our hospital’s monthly morbidity and mortality (M&M) conference. I didn’t really know Mr. R. After all, I wasn’t involved with his care in the ICU, but I was shocked. Mr. R wasn’t supposed to die. He didn’t even look that sick when my team and I admitted him from the emergency department—he just had a simple pneumonia, not terribly uncommon in an elderly man of 72.
Unbeknownst to me and the rest of our general medicine team, after we had left for the night, Mr. R was then taken to the ICU to be started on an insulin drip for his high blood sugars. From then on, his breathing deteriorated, his pneumonia became worse despite aggressive therapy and he was put on a ventilator in the following days and subsequently expired after his family agreed to withdraw care.
But in hindsight, I think Mr. R may have known he was going to die. Tears streamed down his face as I began to gather the history of his symptoms. He kept glancing at his wife for reassurance, unsure about his fate. In the ICU, when I went to visit him, on his first day, he seemed hopeful and nodded excitedly when I told him I would be taking care of him when he got transferred to the floor.
However, Mr. R never made it to the general medicine floor. I gave him something to look forward to that never came to be.
When Mr. R passed away, I couldn’t help but blame myself, even if I was only a medical student and not in charge of his direct care. As soon as I figured out Mr. R was being presented at the M&M conference, I blamed myself for telling him that he would be “okay” that night in the emergency department. Why did I give him false hope? Why did I, as a medical student, try to predict his fate? I know I was fulfilling my role as “the upbeat medical student,” but I felt guilty for being positive when I learned that the outcome was everything but okay.
At that moment, a hundred thoughts rushed through my mind: I should have been more pragmatic and objective; I should be stoic; I should not be cheerful when I do not know the potential outcome of a situation. I should not give false hope.
Reflecting on Mr. R’s situation some months later, I realized that if I don’t give hope of any sort at all, I feel I have failed at my role as a medical student and health care provider. As medical students, we walk a tight line when it comes to dealing with patients and delivering their respective prognoses. It is our faces that patients see first in the morning, and it is us who they ask about their lab results, what the doctor says about their latest imaging and, most importantly, when they can go home. We do not want to disappoint. We want to give them good news all the time—that their cancers are not detectable, that they won’t need surgery again and that they will be home in time for their children’s birthdays. I often feel I need to be positive so my patients feel hopeful about their conditions, even when their diseases are unrelenting.
I know that this is naïve, but I somehow think my optimism can help cure them. And even when it doesn’t and patients like Mr. R pass away, at least I know that the “false” hope I gave them did not come from a false place.