From Michele: As kids, we are told that going to a doctor is an essential for our health. Sick… go to the doctor and you’ll get better. Growing…let’s go to the doctor and make sure that you are growing at the right rate. Etc. Essentially, we start to associate our doctors with our health and we associate them with achieving optimal health. Despite this, we oftentimes forget that those who are taking care of us need to be taken care of as well. Being a physician can be hard in many different ways. So let me ask, who is taking care of them?
So I’d like to introduce you to a girl whom I know personally. While I can’t share her name, let me tell you this… she’s going to be a great doctor. This experience that she had, while difficult, shaped her into an even better physician. Enjoy her story below.
“She’s my age.”
This was the first thought that came to my mind when we went to round on her for the first time. I had known that morning that an interesting patient was coming, so I prepped – reading through her chart my eyes gleamed over exciting words… endocarditis, IV drug user, Suboxone, increasing SOB, 27 weeks pregnant with twin girls… This would be such a fascinating case to follow and learn from. I would take her on as my patient and demonstrate to my fellow and attending how well I could manage this complex, mess of a condition.
All those thoughts went out of my mind when I saw her.
Yes, she was my age – but we looked so different. She looked older, worn with more wrinkles, hair knotted in a mess of a bun with roots of brown growing out from her dark-purple color hair dye. I stood there in my white coat silent and feeling like a naïve child. Her boyfriend looked to be about the same age as well – only he wreaked of cigarette smoke, had cuts all over his face and spoke quite fiercely to staff. He spoke with confidence and authority; but if you listened closely, his choice of words indicated that he had no idea what was going on or what was about to happen.
There were 17 people in her ICU room – 5 from OB, 3 from cardiology, 3 from cardiothoracic surgery, 2 nurses, 2 residents, a medicine intern on his first day… and me.
It was cramped, she was hot and trying desperately to hide her face behind a fan. She looked down when we spoke to her listening to all the physicians trying to figure out the next steps of her care. Her heart was failing – she had a fistula between her aorta and right atrium and a nearly absent tricuspid valve. There was an abscess extending from the aortic root to the mitral valve and severe aortic regurgitation. “Absolutely insane…,” I thought. She had been injecting her suboxone during this pregnancy, despite the notion that you could not get high from it.
No one wanted to touch her – at least that is what I understood.
There was talk of transferring her to Boston, passing the torch of this scary patient. I heard some mutterings that it would not be worth undergoing such a procedure for someone that is likely to continue injection drug use. Many of the surgeons did not want to operate, fearing that she would not survive the hemodynamic changes. One surgeon finally spoke up with a plan for cardiac repair – he would replace the tricuspid with a porcine valve and patch-repair the fistulas created by her abscess. The babies would be delivered by OB prior to her cardiac surgery and we would all brace ourselves after. “I’m assigning you to a different patient – this one is going to get complicated and I don’t want so many people seeing her,” my fellow said to me. I relinquished “my patient” without question – but to me that only meant I would not present on her each morning. I was so worried about her.
A series of unfortunate events complicated the day even further.
The hospital had just experienced the Code Silver in the ICU. Yep, my patient was there. Then her boyfriend was caught with drugs in his backpack after every visitor needed to have their bags inspected. Apparently, he had been shooting up in the parking lot and was subsequently prohibited from entering hospital premises. “This is bullshit,” muttered my fellow. “She has ONE support person and we aren’t going to let him be with her before this surgery? Bullshit.” I silently agreed. At that moment, all my judgement went out the window because of this realization. I didn’t care that he was “a druggie.” I didn’t think he posed any risk to the other patients… why exactly weren’t we letting him in? Of all the people in the world, Dr. Oz popped into my head. Before his über fame, he had appeared on a TV interview during which he stated he never performs cardiac surgery on patients who do not have someone that loved them at home, “Because their heart would never heal.” I remember our patient how she was feeling the morning before her surgery – she barely spoke to us. “All I know is that I am getting a pig heart and that I don’t know if I am going to die or not.” She was solemn, looked lonely. She didn’t even understand what was happening – how could we proceed?
Dr. Oz probably wouldn’t have.
After her surgery, she was intubated. I visited her every day. I would walk up to her bed, say hello, adjust her arm or bed sheets. I was the medical student, but I was also a visitor. Down her arms were deep scars from cutting. Who knew what pain she had gone through. I felt slightly uncomfortable, thinking that it was not right that she didn’t know I was there. But at the same time, I felt that she needed someone visiting her and checking up on her. The boyfriend never came back, although I heard he had visited his girls up in the NICU. I never saw anyone with her- I would go in the morning, the afternoon, and on some days I would sneak in before leaving for home. No family, no friends or coworkers. Maybe they didn’t have a car? Either way it was sad that she was alone. Her lactate was climbing, she looked ashen, hair still a mess. Despite all of the signs, I still held on to hope that she would wake up and if nothing else, have two healthy beautiful girls to keep her company on the rest of her journey.
I would get angry with the staff, who would crowd her room, speak loudly at her bedside. “Don’t they know she can hear them??
How rude!!” Then I overheard the anesthesiologist speaking to my attending. My attending had said, “At least she has age on her side,” to which the anesthesiologist retorted, “Yea, but she’s a 27-year-old in a 50-year-old’s body.” Strong laughter ensued – inside her room! I remained silent, but enraged.
She died. Six days later. Alone.
I went to visit her again the next morning and she was gone. Her twins were up in the NICU, father had disappeared. The last note in her chart is from Child Life – “Patient’s thumb prints painted in a heart shape on 8×8 canvas; patient’s ink thumb prints placed on card stock; two sets of locks of hair for each twin.” How our lives taken us to such different places.
We are all perfectly imperfect.
This is perhaps one of the most important lessons medicine has taught me. It is a difficult concept to come to terms with as a budding physician. Throughout our preclinical and clinical years, we are being taught, even encouraged to judge – judge the condition of the patient, judge the appropriate management and what would go wrong in each scenario. It becomes a whole other level to put those judgements aside and see the human that is not only our patient, but our comrade in this life quest. I learned to put aside my prejudices against people who drink too much, who use drugs, who lash out, who criticize, who disappear … because in medical school I had to come to terms with how imperfect I was time and time again. I was happy I got there. And it was satisfying to see that I had reached this point of near-zero judgment before other physicians who were my elders. Even then – who was I to judge the disgruntled, arrogant physician. Who knows what he went through himself? There is no telling when someone will turn around – and that is something no human will ever be able to judge.
One thing is certain: I can’t imagine forgetting how I felt about Sammy. How raw and fierce my feelings strummed. She will forever be the patient that grounds me and reminds me about the tragic beauty that accompanies death. No matter how different we all are, we are still the same – just different products of the human condition depending on the cards we were dealt. I have been with my patients during their absolute worst, allowed to peek into the scenes of their life that they have kept from the rest of the world and see all the triumphs or tragedies that occur in it.
Sammy will stay with me throughout residency – serving as a reminder to never judge and appreciate the privilege that is to practice medicine.
~Anonymous