Columnist
Icahn School of Medicine at Mount Sinai
Katie is a Class of 2016 student at the Icahn School of Medicine at Mount Sinai, in New York City.
Pleural Space
Pleural Space looks at the experiential curriculum of medical school, the many things that are taught and learned that aren’t listed in a syllabus.
A few weeks ago, I was describing my team’s discharge plan to the patient I had been following all week. We had found an anterior mediastinal mass on imaging, and the pulmonologist wanted to follow-up in a week after immunohistological staining came back. I told him we felt he was now stable, and that we would like him to follow up with the lung doctor as an outpatient within the week. He asked me if he should return to the ER to get his appointment.
One of my friends told me today that she shadowed in the emergency room on Friday night. She told me they had a patient who was pronounced dead on arrival after being shot 24 times. Unfortunately, this is a typical narrative for our emergency room on a Friday night. I wish I was surprised, I wish I didn’t already know the story, and I wish the news of another young life prematurely and senselessly erased from this earth even made the news.
A torrential thunderstorm forced nearly the entire homeless population of Tampa Heights out from under their tents and awnings in favor of the more generous cover of a highway overpass. It was the closest Tampa had come to a publicly funded homeless shelter.
The first day of my medicine rotation, I proudly put on my white coat and stuffed its pockets with my stethoscope, reflex hammer, otoscope and a few pocket-sized books to help get me through the day. The stress and anxiety of taking Step 1 was over. I was going to treat patients! Heal the sick. Comfort those in mourning. I was finally where I wanted to be: in the hospital.
I looked up from my computer to motion the next patient in line and saw before me an elderly gentleman who resembled many of the other patients attending our health fair in Key West. Casually dressed: a white V-neck T-shirt and track pants. Hair: gray and wispy. Skin: tan and leathery from the sun. He was over six feet tall, with an athletic build for a man his age. It was approaching lunch hour and the line for my Med IT station was dwindling.
“In all seriousness,” the attending physician says, “he can wear women’s underwear to minimize the pain.” “Can he really?” “Absolutely,” replies the attending. “If we can’t prescribe any pain medication, then tighter fitting clothing can help keep things from jostling about too much.”
Her story started pretty similarly to any other patient I had over the past week and a half since starting my family medicine rotation. The nurse told me she had another patient who was checking in. I asked her for the name and began looking up the previous clinical notes and labs in the computer while waiting for her arrival from registration. She had a history of arthritis, GERD and uncontrolled diabetes — all diagnoses I had become comfortable discussing with patients.
During morning rounds, the resident and I stopped by our young patient’s room. He was technically five weeks old, but was born five weeks prematurely, so all in all, he was delightfully newborn-sized. The nurse was sitting in a recliner, holding him. He was well enough to be held. We finished rounds, ate breakfast, and headed to the OR. Our work unexpectedly finished early for the day, and I was free to go. Instead of immediately leaving the hospital, I headed back to our young patient’s room.
“If I begin to repeat myself, just tell me. I have Alzheimer’s. At least, I think I do,” the elderly gentleman said with a smile. This elderly patient of mine was a jovial gentleman and in fantastic shape with unremarkable vitals on physical examination. If it was not for his diagnosis of Alzheimer’s disease, the physical and emotional state of this patient given his age is nothing less than enviable.
She asked me if I was from New York. I told her I wasn’t. I was from California, actually, but enjoying myself in New York City while I was here. I asked her where she grew up. She said Brooklyn. She asked to see my referral card. I asked her to clarify. She said she wanted to see my referral card. For coming here. And did the super know I was here? Where was my card?
“I have diabetes.” Shadowing at a pediatric endocrinology office, I was told this statement by a four-year-old patient. As weeks passed, I could not stop thinking about it.
“What can you do here that we can’t do at home?” This question angered my resident. How dare a patient admitted to the hospital ask for justification of their plan? The progress note had already been written and orders entered; assent to the plan was assumed and having to walk the patient through the options would extend rounds considerably. What an inconvenience.
Contributing Writer Emeritus
Schulich School of Medicine & Dentistry at Western University
Dr. Dueck practices emergency medicine, primary care, and addiction medicine. He is an adjunct professor in Family Medicine at the Schulich School of Medicine & Dentistry at Western University and completed residency at McMaster University. He is active in the medical humanities, the author of the blog Aboot Medicine, and co-founder of the student wellness project Western Vitals.
