It was 6:58 a.m. and it was my first day in the hospital as a third-year medical student. I was excited. I had my short white coat on and my pockets were full of little gems recommended by those more experienced than myself. As I found my team I saw the second-day-interns nervously preparing for rounds. I hoped my excitement was not too obvious. I could not believe I was about to round on real patients with real physicians. This is what I was made for, I told myself.
Our attending appeared and everyone quickly gathered their notes and began following him. One intern was so nervous he tripped. We stood in front of the first patient’s room and the intern, who was so nervous just seconds prior, began presenting the patient. “Ms. Smith is a 19 year old AA female with PMH of FSGS, status-post c-section last Thursday who presented to the ED l week ago with HELLP syndrome. She is having persistent fevers, we still have no known etiology … ” The first thing I remember thinking was how young she was to be having a child. I felt old. Next, I remember feverishly drilling myself on what FSGS and HELLP really were. “Crap! I actually need to know all of this stuff,” I thought. The attending asked the team some questions outside the room. When it was my turn I mumbled something about hemolysis and low platelets with my voice quivering and my eyes wide. He said, “Good,” and moved on to the plan for Ms. Smith. I breathed a sigh of relief.
We went into the room and Ms. Smith was watching a TLC episode of a show called “A Baby Story”. The mother was having a c-section and our patient expressed how she missed her son, Jeremiah. He was born at 26 weeks and was currently in the NICU. She was concerned because he was having a spinal tap that morning. We discussed our plan for the day with Ms. Smith and spent the remainder of the morning rounding on our other patients.
Fast forward about a week. Ms. Smith was still having fevers of unknown etiology. We had done an ultrasound at bedside during rounds and it was determined that she had a large pleural effusion due to a Klebsiella pneumonia. The team did a thoracocentesis at bedside. She was nervous but trying to focus on the show she was watching — again, “A Baby Story.” She asked to hold one of the medical students’ hands for when she felt pain, and I placed the photograph of her son in front of her. She smiled and thanked me as the procedure was performed. We finished the procedure and she resumed watching her show.
Fast forward one more week. Ms. Smith was continuing to have fevers of unknown etiology. Her hemoglobin had dropped the night before and she was transfused one unit of blood. We discussed her plan of care in rounds that morning but did not get a chance to see her as she was having a permacath placed. After rounds, we went to morning report. Overhead we heard “Adult Code Blue. 10WS Dialysis Unit.” Our team was on call that day so we ran to the code. I was excited to see my first code — until I quickly realized it was Ms. Smith laying there. She was in PEA. I remember going through the motions of the code — the chest compressions, the waiting. After nine long minutes she came back. She was transferred to the ICU with hypoxic brain injury. I could not believe what had happened — my heart ached for this young woman.
It has been almost five weeks since the events of Ms. Smith. Recently, Ms. Smith has been transferred back to our service on the medical floor awaiting placement in a long-term care facility. As I reflect on the patient who has made the largest impact on my month in internal medicine, both professionally and emotionally, there is no doubt it has been Ms. Smith. She taught me so much — ultrasound at bedside, thoracocentesis, compassion, HELLP syndrome, infection of unknown etiology, how to run codes, and ultimately the common end result of codes. As my rotation comes to an end I find it interesting how paradoxical it is that while Ms. Smith was my first patient, I will be one of her last physicians. Ms. Smith will be the last patient of my internal medicine rotation, and I know I will always remember her for the remainder of my career.