Just a five-year-old kid / Yet always in and out of the hospital, / Since her first beautiful breath / Through each breath after, / With her life-giving / Yet ever-faltering lungs.
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.
We sit in a clumsy ring / under fluorescent lights, / halfway into the allotted one hour / before we realize that we are having / a conversation born a whole decade ago.
For me, one of these moments occurred during my neurology clerkship, a week into working in the Neuro Intensive Care Unit (NICU). 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. All they understood about his condition up to this point was that Mr. R had a heart attack that led to some swelling in his brain.
This piece is focused on the applications of empathy and compassion in decision-making. How can we distinguish between them? In its simplest form, empathy deals with feelings while compassion deals with understanding.
Engaging strangers with kind eyes rather than tender faces, / Air hugs rather than warm embraces, / Family Zoom calls rather than face-to-face visits.
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.
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.
Chief complaint: arm pain, / Waiting in room 4. / As I enter, he looks me up and down — / What is it he’s looking for?
Each morning, Mr. E had a new concern — too hot, too cold, too dizzy, too stiff. He was admitted for what seemed to be a straightforward heart failure exacerbation, but his echocardiography showed severe hypertrophy in both sides of his heart that the cardiologists described as “concerning for infiltrative cardiomyopathy.”
We’re overloaded with so much advice, so many ideas on how to be a better doctor, / how do we decide what to follow and what to ignore?