Contributing Writer
The Geisel School of Medicine at Dartmouth
Vivienne T. Meljen is a fourth-year medical student at the Geisel School of Medicine at Dartmouth ('17) and a graduate of The University of Scranton ('13). She will soon be beginning her residency in Obstetrics and Gynecology at Duke University Medical Center. She is a 2013 Truman Scholar and National Health Service Corps Scholar interested in working with medically underserved populations. Vivienne first learned about Narrative Medicine through an English course in college and is taking strides to begin to share her stories. She takes pride in her education and work as a physician-to-be as well as spending time with her family and enjoying outdoor action sports any time of year and anywhere.
Follow her on Twitter: @StethoscopeOn
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.
“Ms. Mary is very excited to spend time with you,” the nurse said on my first day of hospice volunteering. From behind the nurse’s shoulder, I saw Ms. Mary rolling her power chair toward us, a toothless grin on her face. She looked up at me, her nasal cannula hissing with oxygen, and greeted me with her hoarse voice. I turned around to see that the nurse had dashed away, and left me alone to take care of Ms. Mary, who had heart failure, COPD, chronic pain and many other medical conditions.
How can doctors-in-training learn to have hard discussions with their patients? Will, a fourth-year medical student intending to become an internist, recounts two formative patient encounters he had during his third year. In the first, he learned from an attending physician and a man dying from cancer the challenges of determining when it’s time to end treatment. In the second, he realized a non-English speaking patient did not understand that she had lupus, and thus took the initiative to more effectively translate to her what the condition meant.
On Valentine’s Day weekend last year I found myself at Paddles, the local dungeon in New York City’s Chelsea neighborhood, for the first time. I was perched at the alcohol-free bar when a man politely introduced himself as a human carpet. He asked that I tread on him and lay on the floor to demonstrate. A professional dominatrix-in-training stepped onto his chest and buried her stilettos deep into his belly. His eyes were closed, and he looked calm — blissful, really. As a medical student, I winced, imagining the arrangement of his delicate organs in relation to her vicious heels.
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.
Inpatient neurology at UAB is a busy service, accepting a variety of calls every day from the ED, inpatient consults, and transfer patients throughout the state. On a particularly hectic Wednesday afternoon during my second week of rotation, our team received a page from the psychiatric ward that one of their patients, Mr. S, was being transferred to our floor after a possible seizure. The residents were busy checking out patients to the night team, so I was sent to see the patient first.
It was Friday of the seventh week of my family medicine clerkship. I was tired. Tired from the day and, honestly, tired from the clerkship. I was ready for a change of pace. The next patient was Mr. S., a 30-year-old male, here for an establish care visit. I did not recognize the name. I reviewed his chart before the encounter, two visits in the system, both to the ER for cocaine-induced angina. I stereotyped him immediately. Not that this was right, but I did. I think everyone does.
“It hurts when my sister steps on me and when I bump this spot on something in the house,” the enthusiastic boy said as he pointed to the offending bump on the big toe of his de-socked foot, eager to help me diagnose his problem.
The circumstances under which Jane and I met were less than ideal. That day, I had already seen a family of maggots making a happy living in someone’s foot and been chastised by my attending for failing to recognize the imprecision of my visual acuity in assessing a patient’s ascites — how else could I do so without a measuring tape in my pocket and daily charts of his abdominal circumference?
I used to work as an anesthesia tech at a hospital in Austin, TX. I was surprised the first time a doctor asked me, his incredulous tone dripping with disbelief, “Why would you want to want to go to medical school?” It wasn’t the last time that happened, it wasn’t exactly making me excited to go to school, and it wasn’t a flattering reflection of the doctors that said it, but physician cynicism about the future of health care wasn’t something new to me, either. People fear change, but I think people’s perceptions about impending change are shaped just as much by their perceptions of themselves, especially the interacting dynamics between themselves and their evolving environment.
Truthfully, I pick her name off the new patient list because it belongs to a woman, and several of our male patients have already come upstairs flagged for aggression. It is too early in the morning, and late in the week, and I haven’t yet learned that female patients can be just as unpredictable as the men. I am in a hurry this morning, and I make the mistake of not skimming through her chart before I go in to see her. I don’t know any more than the barebones: her name and her chief complaint upon admission.
Contributing Writer Emeritus
University of Louisville School of Medicine
Erin is a Class of 2016 medical student. She has a B.A. in English. She took a year off before medical school to work as a Emergency Medicine scribe, and to learn how to make cupcakes from scratch. She enjoys discovering the story-telling inherent in every patient encounter.
