Seeking to document the experiences of students in street medicine groups at medical schools across the country, I decided to start with my own institution, the University of Illinois Chicago College of Medicine.
Children raised in foster homes tend to have a high morbidity. They have developed a similar prevalence of serious physical and mental problems comparable to those of other disadvantaged children populations.
I prepared myself to discuss lab results and dietary counseling. But then my eyes stumbled upon the words on my screen that seemed to be staring back at me: ‘Lung cancer, metastatic to the bone.’
Training to become a physician is not only about acquiring knowledge, but also learning to impart that knowledge upon others — most importantly, our patients. But, in this process of knowledge transfer, is it possible that the information we deliver becomes akin merely to the terms and conditions of a software agreement, the obligatory pop-up hastily scrolled through and accepted by the user — in this case, the patient?
I had not yet guided a ‘goals of care’ discussion. This is the discussion that entails understanding a patient’s wishes regarding end of life care, and it is often in the context of determining what advanced medical interventions the patient might want. That day, my short white coat felt shorter, like it was yelling out to everyone I encountered that I had no idea what I was doing.
While I knew little about these patients at the beginning of the day, I always started out knowing one very important fact: they were already dead.
They asked me how that encounter had gone, and I could feel my cheeks turn bright red. I was embarrassed that I was not able to connect with my patient.
Drawing from this discussion of humility, one can see that we are not so different from our patients, which may seem obvious but is too often not embraced. We are all limited; that is the natural order of things.
“If I don’t get a cigarette right now, I’m going to punch someone,” he said. “Okay, I understand. One second.”
To keep breathing does not mean to go at it alone or to put up a brave front even when it feels as if the world is collapsing. To keep breathing is to always push towards the goal even when it’s hard and even when it doesn’t feel worth because it will be in the end.
His right leg jittered beneath his orange, prison-issued jumpsuit. The manacles across his wrists rattled with the chain connecting them to the cuffs around his ankles.
Through my patient’s same wants and needs, I saw my own thoughts, feelings, hopes, dreams, fears and my own desire to be liked, to be wanted, to be needed. I felt, for the first time in a very long time, a genuine human connection.