Mr. G. was in his seventies, status-post Whipple procedure for pancreatic cancer complicated by more things than I can list in a one-liner. I had joined the surgical oncology team on day fifty-something of Mr. G.’s hospitalization, thus missing the “excitement” of all the times he had gone back to the operating room for abdominal washouts and the interventional radiology suite for drain placements.
After following Mr. G. on rounds for my first few days on the service, I noticed that one day he seemed a little off from baseline. He was hard to wake up and unable to adequately answer our team’s questions, including basic ones like how he was feeling or if he was in any pain. Later that afternoon, I went back to do a quick mental status exam: he knew his name, but he did not know where he was. When I asked him what year it was, he thought it was the 1990s.
With no other objective findings explaining his altered mental status, we concluded that his delirium was most likely secondary to his extended hospital stay. We made sure he was seen by the geriatrics and psychiatry teams. They agreed with our assessment and left a recommendation for him to go outside. That became the big “to-do” on our long list of plans for all the patients on our service. But, every time we’d ask the physical therapists to take him on a walk to get better oriented with his surroundings and see some sunlight, Mr. G. would refuse. He was a stubborn man.
As a medical student, I had a lot more time to spare compared to the rest of the surgery team. And so, attempting to take Mr. G. outside became my job. Every day, I would visit him when the sun was shining most brightly in through the window to entice him to go outside. One afternoon, after I asked him three different ways, Mr. G. finally snapped at me.
“You’re a smart girl, so stop asking me the same question over and over again. I’m not changing my mind. I don’t feel well; I don’t want to go outside.”
So, we made a pact: I would stop asking him if he tried going outside just once. He agreed, albeit reluctantly. The next day, I called the nurse, the patient transport service and the physical therapists to help me transfer him from his bed to the wheelchair. We were finally rolling; I was taking him outside!
We sat down around a table outside the cafeteria. The sun was shining right in his eyes. I asked if he would like me to turn him.
“No, please don’t. It feels nice.”
And we started chatting. The last time he had visited his hometown in Greece was ten years ago. His favorite food was his wife’s handmade penne. He had his own painting and landscaping company and missed working outside. He said that I reminded him of his granddaughter who lived out of state and hadn’t visited in a while.
In turn, he reminded me of my grandfather who had passed away in 2012. I lost a great mentor in my life that year. But by talking to Mr. G., I felt like I was back with my grandpa, embracing the sun shining in our eyes up on the roof of his home in India as he told me stories of his life adventures.
Mr. G. invited me to dinner with his family at his house; I thanked him, knowing in my head that home was probably not in his discharge plans for a while given his rehabilitation needs. As we rolled back to his room, we passed the hospital gift store. He pointed at the flower plants, noting how beautiful the red ones were — but not as nice as the ones he had planted at home, of course.
As I took Mr. G. back to his room, I felt so accomplished. Yes, some of my fondest memories as a medical student had been actively assisting surgical cases in the operating room, but this was by far one of my favorite clinical experiences. Per our talk, Mr. G. and I made sure to specially request pasta for his dinner that evening — even though it did not technically fall under the description of a “soft mechanical diet.”
The next day was my last on the rotation. Over the past twenty-four hours, Mr. G. finally had eaten enough to meet his nutritional needs. If he kept on this track, he could avoid the necessity of IV nutrition.
There was a twinkle in his eyes as we went through our morning rounding questions. I brought a plant for him from the local grocery store; unfortunately, it didn’t have any red flowers. My team laughed at it because it looked odd, but I had chosen it because it only seldom required watering.
As I left his plant on the shelf next to the TV, his parting words were, “Why did you spend the money? You’re just a student.”
I looked at him and smiled. “Don’t worry about it,” tearing up because that is exactly what my grandpa would have said.
Medical Student Editor
University of California, San Diego School of Medicine
Sohini Khan is a fourth year medical student at the University of California, San Diego School of Medicine. In 2014, she graduated from Caltech with a BS in biology. She will be starting residency in general surgery this summer and plans on pursuing a career in surgical oncology.