“I have seen how the seemingly smallest gestures often provide the most immense comfort. Paradoxically, it is perhaps in those moments that we have the greatest power to heal.”
RB Weinberg, Annals of IM, 2012
Ms. G was between shades of a deep mustard and malachite when I first met her. It was late in the evening, my first time on call during my Internal Medicine rotation. She was transferred from an “outside-hospital,” –that mysterious facility where all transfers come from. My team and I entered the room just as the transport team hoisted her off the stretcher. I gawked as her swollen abdomen rocked back and forth like an enormous gelatinous orb, appreciating ascites, fluid in the abdomen, for the first time. Ms. Green became “my” patient –as patients often do when they are admitted in the presence of a third year medical student. That night, we began getting to know each other as I helped her order dinner and get acquainted with the hospital Wi-Fi.
It was early in third year and Ms. G was my only patient. I visited her every morning and evening and sometimes in-between. While our discussions had little to do with receptors and pumps, Ms. G taught me some of the most enduring lessons of that year.
We talked about her three sons, two daughters and sixteen grandchildren; about her time as a chef in a local restaurant; about her aching bones; about wisps of white smoke she called “pac-men” that danced for her some mornings. At sixty-one, Ms. G was at once young and old– yearning for the upcoming years of grandchildren and playgrounds yet nostalgic for the highs and lows of youth. She was young enough to be considered for a liver transplant yet old enough to have sustained liver damage from years of alcohol use.
Despite the numerous tests, beeping monitors, and permeating stench of bedside urinals, Ms. G remained hopeful. She connected with everyone, from the lab technicians who prodded her fragile veins, to the technicians who wheeled her from test to test. In a rare embodiment of multidisciplinary care, I watched as the hepatologists, anesthesiologists, nurses, social workers, and internists came together to discuss what was best for Ms. Green.
Ultimately, Ms. G did not qualify for a liver transplant.
“A week or so…” my attending announced. It was then when I first learned what it means to tell a patient that she is going to die. The room became cold. Ms. G did not move. She did not even blink. Dense, crushing sadness cloaked her yellow eyes. Suddenly, she looked exhausted, hollow almost. I wanted to hug her. I wanted to bury my face in her shoulder and sob. Yet, my heels remained planted, my gaze unable to face hers.
Ms. G made it clear that she wanted to die at home. Shortly thereafter, we prepared for her trip to her house two hours away. Her transport team arrived. One of her lines was still in place, only able to be removed by interventional radiology (IR). It was an oversight on our part. As we scrambled to get IR assistance up to her room, her nurses called to inform us that the transport team was getting ready to leave without her. I offered to go talk to the transport team. Once up there, I found three visibly frustrated men wrapping up their equipment. I admitted that the delay was our fault, and gave them a timeframe, which was apparently all they had really needed in the first place. They agreed to wait and took Ms. G home when she was ready.
I said goodbye, and instinctively the words “see you later” slipped from my mouth. My words lingered, buoyed by their betrayal.
That was Ms. G’s last night.
Having Ms. G as a patient made me acknowledge the limits of medicine, an art I so deeply wanted to master. She showed me that tests often don’t hold the answers, and that when patients die, we are forced to confront our own mortality.
On an operational level, I learned that caring for my patients means actually caring about them. It also means caring about everyone else who cares for them. As medical students, our place on the team can sometimes feel inconsequential and it can be challenging to find ways to contribute in a meaningful way. But, it is precisely this position that allows us to be privy to insider information and gives us the luxury to make the extra effort – which may seem trivial but can actually make a great difference. I found myself embracing this role throughout third and fourth year. Whether it was giving patients information about weight loss or googling addiction resources, it was an easy way for me to stay engaged, reap the rewards we all went medical school for, and contribute to the team.