Hey guys, how's everyone doing? So, apparently, I'm signing on to this blog for the first time in over a year. I've had moments where I wanted to blog over the past year, but the 2nd half of 3rd year turned into a whirlwind, and the first half of 4th year wasn't all that much better. Things have started to calm down for the first time in over 3 years, and maybe I should take advantage of it, and jot down some of my thoughts at this time.More specifically, this week has been a bit of a mini whirlwind on its own due to several reasons, but one of which is from the hospital. I'm currently in my final week of what is my final internal medicine sub-internship, and for the most part, it has been pretty nondescript. But, all of a sudden, I was switched to an overflow service, and I met Andrea (obviously not her real name for the sake of patient privacy).
When I first walked into the room to do my initial H&P of Andrea, I noticed right away, the telltale signs of an oncology patient. You see, I hadn't read her chart yet, because a nurse was using it, and a resident in the past had challenged me to not rely on a chart before conducting any H&P. Andrea was wearing a hair cap, most likely hiding her exposed scalp due to recent chemotherapy, her abdomen was swollen up due to a combination of ascites and a massive metastatic secondary tumor, and her skin seemed dry and webbed at specific areas, most likely from her radiation. She looked straight into my eyes looking for information and clues as to what my internal thoughts were about her prognosis as I spoke and asked her questions. At each step of my physical examination, she asked for my findings, and what they meant. I had never met a patient who showed so much interest in her H&P, and who looked so fearful of death.
After getting to know her as the week progressed, she and I built a bit of a rapport, as she kept asking me to come back and check in on her throughout the day, each day. She spoke to me about how lonely and cold it gets during the evenings and nights on the hospital overflow unit. This unit tends to attract the least amount of attention from attendings, who seem to scurry in and out of the unit within a couple of minutes, and the nurses and pca's even seem like they pay a touch less attention because these rooms were never meant to hold patients, and the cramped quarters and limited resources make it that much more difficult to provide standard of care to the patients. Andrea asked me pointed questions about her prognosis. She had Stage IV endometrial cancer, which gave her a less than 15% chance of surviving 5 years since her diagnosis, which was a few years ago. I offered the best information I was able to recall on the spot to her, trying to be as gentle as possible, while still staying firmly in the truth, with the straight numbers, telling her that the numbers were one thing, but they only help in retrospect, and no one knows how any individual person is going to survive until it all plays out. I gave her my metaphor about being a fighter in life. She responded saying that she's thought about giving up, countless times, and at one point in her life, she was ready to go, but not anymore. I tried my best to encourage her to keep getting back up each time she finds herself down, because fighting in life doesn't mean you're always competing at a high level. It means that you always struggle, and get yourself back up each time you get knocked down. Because everyone gets knocked down, we're all human. We ended up having a good long conversation, that continued on to her marriage, her childhood, and her faith in God. It was a real blessing to know that she had faith in Jesus and that she was also encouraged to hear that I was a fellow Christian. We prayed for each other, which is something I haven't done with a patient in months. I pray even now that she'll find strength and hope in her eternal life in Jesus, our Lord and Saviour. Throughout the whole conversation, she would look into my eyes, looking for assurance that I believed everything I was saying. I don't know how, but I'm thankful I was able to think clearly, and stay calm this whole time and show it through my speech, eyes, and holding her hand, because she commented on my calmness. She asked me not to lose it, and of course, to keep seeing her as long as she was in the hospital. She told me that she needed to be touched by someone, which is disheartening considering how many doctors, nurses, students, etc. are hustling and bustling around the medical floors.
I think that a lot of healthcare professionals tend to emotionally detach themselves from the tougher patients. The ones that keep asking how they are doing, when it is clear that their prognosis is the worst. The ones that people can't seem to look into their eyes on a regular basis in an effort to offer compassion and encouragement. Maybe that's why so many of the attendings I see just run in and out of a patient's room in a timespan of a few minutes. Self-preservation.
But that is also why I look up to both young and older, but especially the older attendings who have practiced in the inner-city hospitals for many years, who still show compassion and are exemplary professors of medicine through not only the way they speak to each patient, but the high level of competence, and attention to detail through which they design the treatment plan for each patient. They even patiently teach us students as they do all of this. I want to get there one day. I know its impossible to be like that anytime soon. You can't be that way unless you're smart, and unless you learn the ins and outs of practicing medicine in the real world through years of experience and learning from other physicians and colleagues. But all of that is one of the main reasons why I'm happy to be in this long, demanding road in medicine. I gave up some crazy years, and sacrificed a few deeply important things that were tough, but I think it was a fair trade off.
Hopefully, the way I practice medicine is used by God to shine His light in this world. I don't know how it works, since I'm far from being a faithful believer, but thats just the way He works.
well, I don't know. thats it for know. perhaps i'll refine this post later on, but these are just some quick thoughts from the past few days in my sub-i.
