The Most Important Thing: First Day on Wards
Most of all though, I tried to calm my racing mind and remind myself to just learn. And with that, I wondered, “What is the most important thing I can do today?”
Most of all though, I tried to calm my racing mind and remind myself to just learn. And with that, I wondered, “What is the most important thing I can do today?”
I opened their chart and scrolled to the recent notes section. A new title I had never seen before popped on the screen. There, at the top of the chart, “Deceased Note” was written in bold letters.
Upon reflection, my actions and feelings in caring for this patient reveal how truly afraid I was to be wrong; not necessarily about the diagnosis, but rather about whether the patient would be okay. Maybe coming in daily and opening her chart for good news was just me hoping that my initial impression was still right instead of coming to terms with the fact I was very wrong.
Many patient encounters, often brief, have left me with a lasting impression. I reflect on these moments by capturing the dialogue, gestures or quiet observations that occur when caring for patients.
I would be lying if I said I remember every single patient that I have seen in the past almost two years of clinical rotations. However, each of my core rotations has become defined by one or two patients that most stood out to me.
During my pediatric rotation, a little girl was brought to the ED the day her family was set to leave for vacation. Her physical exam and imaging confirmed a ruptured appendix that would require surgery and almost a week of IV antibiotics, meaning our patient would miss her family’s forthcoming vacation.
It was the first day of my inpatient internal medicine rotation and I felt as excited as ever to be in the hospital, participating in rounds. “How’s your day going?” I asked automatically in a cheery tone as I entered my first patient’s room.
When my family saw me painstakingly hand-placing individual sprinkles on the apices of buttercream rosettes at age 15, I justified this obsessive behavior by telling them, “I’m just practicing precision for the day when I get to inject into people’s faces.”
My mother likes to tell the story of how, as a small child, I referred to the superficial wounds sustained in my first head-over-handlebars accident as an “abrasion.” I remember staring at my knee, fascinated by my body’s ability to heal itself. The sacred anatomy of wounds, atoms as spacious as galaxies, coalescing and woven with no instruction of my own to renew what had been lost.
During the last week of my clinical rotation in family medicine, my attending advised me and the accompanying medical student that going forward, the health providers of the clinic must limit their scope of care for patients who present for annual examinations.
Last year, I walked into a big hospital room towards the tiny NICU bed with a tiny baby in his space helmet. The moment he came out of that helmet, which was pumping in 100% oxygen, he would start deteriorating.
It is morning outside, the sun barely kissing the horizon. The curtains have been drawn in an attempt to force any lick of light from the room. But one slim shard cuts through the drapes, illuminating John’s face.