From the Wards
Leave a comment

The Privilege of Patient Care

“My room is too hot,” he insisted, shoulders hunched and feet shuffling as he stared down at his matching set of striped pajamas. “I’m always so hot in here, but I’ve asked them so many times to turn it down already.”

I always found myself saving Mr. E for last on my list during pre-rounds. I told myself that it was so I could justify taking the elevator back up, as he was on the lowest floor out of all my patients. Each morning, as I approached his room, I could see the door already swung open, the curve of his striped pajama-clad back as he faced his window and the large expanse of the city beyond, a constant reminder of the life he had put on pause.

“I have bills to pay, and jobs to do, and my family to take care of,” he said to me. His hands twitched in his lap. “I feel like I’ve been kidnapped and captured here. I don’t know how to explain it to you.” When I pressed it further, he refused to clarify: “I just have so many things to get back to.”

Each morning, Mr. E had a new concern — too hot, too cold, too dizzy, too stiff. He was admitted for what seemed to be a straightforward heart failure exacerbation, but his echocardiography showed severe hypertrophy in both sides of his heart that the cardiologists described as “concerning for infiltrative cardiomyopathy.”  For me, this was intriguing; as a fourth-year medical student with only one year of clinical training under my belt, the autoimmune diseases I’ve come across in actual practice have been few and far between. Mr. E, however, seemed completely uninterested whenever I brought up the amyloidosis they had found on nuclear imaging.

“I’m still processing,” he said, tight-lipped. “I have nothing else to say right now.”

Each morning, I sat down on the chair across from him, brows furrowed over the sweat forming above my mask. When I brought his issues back to the team, we discussed his case: he was not actively sick, he had almost returned to euvolemia, his blood pressures were fine. He was not decompensating, short of breath, or having chest pain. But each morning, I was confronted by a  stifling heaviness in his room — the way that he sat, stock-still and subdued, on the edge of his bed. Selfishly, I felt heavy too. It was difficult for me to check on him because I did not have sufficient comfort to offer other than “I’m sorry you’re feeling so awful” for the twentieth time. I could not make sense of his misery. It felt like, even though we were treating his physical conditions, he was still waiting on a solution.

Finally, on the sixth day of his admission, I resumed my daily walk towards Room 22, watching his hunched silhouette grow in my line of vision.

“Mr. E,” I called out, stepping into his room over the noise of his television and beeping on his telemetry monitor. “I have news for you. How would you like to go home today?” I had never seen his face light up before, wide gaps in his teeth as his mouth arched into a crooked, disbelieving smile.

“Really?” he stood up, clinging onto the pole of his IV drip. “Are you serious?” When I said yes, he immediately dropped back into his seat, cradling his head in his palms, eyes downcast. Startled, I sat down next to him, tentatively patting his back: “Are you okay, Mr. E?” He looked back up at me, and I drew in a breath. There were tears in his eyes, face crumpling in complete contrast with his usual stoicism.

“It’s just been so hard,” he whispered, almost pleadingly, “I can’t believe it. I’ve never been through anything like this in my life before. I’ve never been here for so long.”

At that moment, I felt the fog clear. After a prolonged hospital stay and a slew of new diagnoses, medication changes and follow-up appointments, all of his vague complaints and constant requests to leave culminated in one truth: he was terrified. I reached out to place a hand on his knee.

“I’m so sorry,” he said, bottom lip quivering. “I don’t want to be a nuisance. I just want to go home.”

We worked through the rest of his discharge together. I printed him copies of his new medication list and specific instructions, walking through it with him to ensure he was understanding and processing what this new diagnosis truly meant for him going forward. When the nurse paged our team that he had more questions, I sprinted down to his floor, weaving my way around the nurse’s station towards his wide-open door, where I could see his already full dark green suitcase as he sat beside it on the stark white sheets of his hospital bed.

“Mr. E,” I greeted. But he immediately began to apologize: “I didn’t want to make you run down here again or to make your job harder –”

I took a seat again in the same chair, facing him directly.

“You’re helping me be better,” I told him.

In training, they remind us that it is always easy to take care of the patients we like and relate to — the ones with interesting hobbies and supportive families and pleasant dispositions. When people ask me which patients I remember, I can easily recite the ones with whom I connected most deeply, established a rapport, and found myself in their struggle, their stories. I can always remember the people that I understood.

In practice, however, it is the people who are more difficult to access like Mr. E who have taught me just as many, if not more, valuable lessons about true empathy and guidance. When we treat patients, we are not only treating diseases, but holistic humans who experience pain, fear, and oppressions and inequities under the broken systems of our current society. Finding a solution for diseases or conditions is important, but so are the factors that affect these people most tangibly: their symptoms and their strife. For Mr. E, it was the vulnerability of being in an unfamiliar hospital bed surrounded by strangers, bearing the weight of the outside world while he waited with uncertainty inside hospital walls.

When we enter a patient’s room, we are so privileged to experience their most intimate feelings of suffering, hope, fear, and hopefully, joy. Especially considering the recent acknowledgement and protests against the systemic failings and violence in our society, it is more important than ever for us as future health care providers to recognize our potential to uplift our patients with the privileges we hold in the deep pockets of our white coat.

Before his discharge, when I ran his medication list with him one last time as we sat together in his room, Mr. E suddenly reached over and gave me a one-armed hug — something that, in context of the recent pandemic, was jarring, but I found myself naturally reciprocating.

“I’m sorry,” he said, “but I really wanted you to know how much I appreciate all you have done.”

It is difficult to adequately articulate how much I was the one should be grateful. As a learner, I carry so many patients’ stories within me, hopefully to help me become the kind of physician I strive to be. As a person, I carry these people, like Mr. E, with me — and I will continue to carry them onwards in my life — hopefully to help me become the kind of human I strive to be.

Jennifer Li (3 Posts)

Medical Student Editor and Contributing Writer

Emory University School of Medicine

Jen is a fourth-year medical student at Emory University School of Medicine in Atlanta, Georgia. In 2016, she graduated from Emory with a Bachelor of Arts in English concentrated in multi-ethnic contemporary American literature and a minor in Music. Jen is passionate about addressing healthcare disparities, highlighting intersectionality and patient-centered care, narrative medicine, and mentorship/education. Aside from medicine, she also enjoys poetry, piano, tennis, indie concerts, Asian-American media, and spending too much time in coffeeshops. After graduation, she aspires to pursue a career in Internal Medicine.