For the past four months I have been teaching the first and second medical students at my school. I am one of the 24 teaching fellows. I feel honored and grateful to have the opportunity to not only influence my underclassmen, but also to explore my abilities as a teacher, mentor, and student of medicine myself. Two and a half weeks ago, I joined my classmates in the wards and have had to adjust to the mindset, skill set, and stamina that is demanded of you when on internal medicine. My team and I have seen some interesting things these past two weeks, but today seemed to be exceptionally sad.
I’ve changed the names. Last night, we got the results back from Mr. Jackson’s CT and it didn’t look good. The word “spiculated” was in the Conclusion section under #1 of the radiologist’s report. As a provider that is the last word you want to read. It means cancer and usually a pretty bad form of cancer. Let’s take a step back though. Mr. Jackson, who has a heart condition, is on blood thinning medication and came to the ED 4 days prior for a hematoma that had developed on his left thigh. He wanted to make sure it wasn’t infected because it was looking a little suspicious. He also had a productive cough, but didn’t think anything of it since he has COPD. It’s pretty much protocol for everyone to get a chest x-ray when they come in the ED and have any signs or symptoms of lung dysfunction. So his x-ray had showed something mass-like and warranted further studies, a chest CT. And that brings us back to spiculated. Mr. Jackson has a large, spiculated mass in his lung. Spiculated means it looks like a starfish. It is invading and stretching out in a finger like manner. I can guarantee that was the last thing Mr. Jackson thought we were going to tell him when we admitted him. So last night we ran Mr. Jackson over with a bus and I had to watch a grown man lose it. He has no family here, no friends. Watching him was difficult. Watching him process what we just told him was heartbreaking.
Then this morning Mr. Edwards, who was admitted for decompensated CHF and severe mitral and tricuspid regurgitation, was told that a third heart surgery was pretty questionable. Yesterday his cardiologist said that they were considering fixing the mitral regurgitation to help take some burden off his heart and lungs. Mitral regurgitation means the valve leaky. So, normally blood goes from the atrium to the ventricle and the mitral valve is supposed to keep it from flowing backward. However, in Mr. Edwards’ case there is a lot of blood that flows backward which then puts more pressure on the atrium, the vessels in the lungs, and the other side of his heart. Overall, not what you want to see. Mr. Edwards was crushed by the prospect of not receiving any more help for his condition. He started crying and said “well at least I’ve lived a good, long life.” As a student, as a 26 year old, what do you say to that? He’s a widower, he has very serious medical conditions that limit his ability. He does have a daughter though who takes great care of him and who he is very grateful for. He told me numerous times. One can only hope that when you reach that stage of life you have loved ones around you that you can depend on like Mr. Edwards has. Unfortunately, that is not the case for most people.
Now we move to our last sad moment today. Mrs. Ramirez is a 47 year old with a history of heavy drinking. She said she would drink a bottle of wine by herself everyday. She had been sober for the past 6 months, which was great. However, the damage was already done. She had liver failure when she walked in the door. We soon found out that her kidneys were also failing most likely due to her liver. Then her lungs failed. She was bleeding out of every orifice and was found to have an allergic reaction of sorts to the blood thinning medication that we were giving her. Over the past two weeks she has declined pretty rapidly. Palliative care was able to convince the family and husband that there was nothing more we could do for her and they should consider letting her go. What I found really sad about Mrs Ramirez’s case was before her admission to the hospital, her and her husband were not on good terms. I never found out why, but they were fighting before she came in. She was intubated and sedated for most of her stay with us. So he didn’t really have much opportunity to talk to her. Maybe it didn’t bother him, maybe they were on better terms than the family let on, but I know that kind of situation would tear me up inside. This afternoon at least a dozen of Mrs. Ramirez’s family members had gathered around her bed. He ventilator was turned off. The medications keeping her blood pressure were turned off. She didn’t struggle. She didn’t move. She didn’t breath on her own. Her blood pressure became undetectable. Her heart slowed down over about 10 minutes until it stopped. She died very peacefully, with no pain, and surrounded by much of her family. Being the first person I’ve ever seen actually die, it was pretty sad. She was only 47. She has kids, young kids. That’s all I could think of when I watched her heart rate drop lower and lower.
Today I spent a lot of time just listening to patients. As a student you have that luxury to sit with your patients and make them feel heard. It’s not that physicians don’t or don’t want to. It’s just we have far fewer patients to see than our attendings so we have the time to linger a little bit longer and have them tell you how they really feel about what the doc just told them. As a student, these moments are the most rewarding and I can imagine cathartic for the patient. The power of silence is tremendous and often times underestimated in our society today. You don’t need to always respond. They’re probably not waiting for you to respond. They’re probably not going to listen to you if you did. What you do though, they will remember. Lean in, touch their hand.
Today I also saw the importance of healthy relationships. It made me realize more than ever just how important having family is. It made me realize how in the end so many things become trivial. It made me think about all the things we prioritize over quality time with those we love and with the activities we love. Do you want to be on your death bed with a list of shoulda, woulda, coulda’s? I know this is something that people say all the time and is definitely something I have said in the past to people, but words are only words. We should live the life we want, not just dream about that life. I think being on the path I’m on makes me feel like the life I want is on pause. My boyfriend lives in NY. My family is in CO. I have no relatives in SoCal and I rarely do the things I love, hike, photograph beautiful things. I often times feel alone. So how do I change that? How do I feel like I am fulfilling my goal of becoming a doctor AND living life to the fullest? Baby steps is probably the answer. Obviously I don’t have the answer, but it is something I think about often, especially on days like today.
This post kind of turned into me rambling, but I just needed to get this out. I am so grateful and humbled to be on this path and to be a part of my patients’ support network. Every interaction I have gives me new insight, new perspective, and a greater appreciation for how finite life is. So, if you read through this entire thing I ask you 4 things: 1) consider mending a broken relationship (tall order, I know, but is it really how you want to leave things?), 2) spend some time this week doing something you’re passionate about, 3) complete a random act of kindness tomorrow (small gestures can have profound effects), 4) take some time this week and reflect on your life. Are you happy? Are you pursuing your passion? Do you feel like you’re missing something?