As a first-year medical student, I was encouraged to talk to patients when participating in my required clinical observerships. During one of these sessions, I had an encounter with a patient that emphasized to me the vital role of clinical experience in medical education and significantly altered my perception of my future profession.
This patient immediately gave the impression of someone who was respected by those who knew her. Although she had lived simply and her stories were modest, her oral storytelling had the clarity of thought that marks a skilled speaker. I was impressed by her ability to recall all of her medical history of the past two years, which was considerable, and she was engaging and present as we talked.
In fact, she dominated the conversation, in a pleasant way, as she led me through her career as an elementary school teacher, her significant relationships, and her frustrations with her current condition. If I had not sat down and spent considerable time with her, I would have likely assumed that her presenting complaint (a bacterial pneumonia) was her only concerning health issue. Sitting still on the edge of her hospital bed, she gave almost no sign that she had suffered a stroke a year prior and was experiencing left-sided seizures and short-term memory loss. The only visible evidence was a slight tremor of her left hand that became especially noticeable when she would take a sip from her bottle of Diet Coke; I might have missed it if I had not been looking for it.
The memory loss was the most upsetting symptom. She would have forgotten my name if I had left and returned 15 minutes later. Even remembering old friends' names, she told me, took effort, when she even remembered at all. I thought about how difficult this would make relationships. How would I connect with my friends without an immediate recollection of our shared experiences or even knowing their names? Although she did not say so directly, I could infer from her stories that her relationships were suffering. In addition, she was no longer allowed to drive, and she was not sure where she was going to live once she left the hospital.
I thought it unfair that a person who seemed so responsible and respectable should have so many obstacles thrown at her at one time. Sadness and pity welled up inside me. I wished she could be cured. I wished I were wealthy so that I could donate money to neuroscience research. I wished I could do something, and it angered me that I could not. Then, the woman smiled and said, “I've always rolled with the punches, though. I think that I'll just continue to do that.”
I realized she had not been looking for my pity. In fact, she was enthusiastic about many things in her life, and my focus on her disabilities had clouded my ability to notice this. Her grandchildren were still young and she wanted to see them grow up. She was an amateur artist and had a goal of drawing again. She was looking forward to sitting on a bench outside and enjoying the summer weather. Although they had been modified, she still had dreams and goals that made life worth living. I was genuinely taken aback by her attitude: She was accepting of her condition, and hopeful about the future.
As I discussed my experience with my supervising physician, he encouraged me to not label diseases, even terminal illnesses, with terms such as “sad” or “tragic.” Whether your patient is an Olympic athlete or quadriplegic, he explained, it is better to simply accept patients as they are and try to improve their lives in some way. Even comfort, if that is all that can be offered, may be sufficient.
He told me that medicine does not always provide a cure, and although I had previously known this as a fact, it did not become emotionally real to me until I met this patient. She could never be cured, but we could help her, and my listening ear may have been just the treatment she needed that day.
Because I am someone who likes solving problems, it will take time before it is natural for me to think of myself this way: as someone who helps rather than heals. I have noticed that it is a distinction not covered adequately in the medical school classroom, perhaps because we in medicine are, on the whole, a proactive group. We would rather focus on the science behind a curable condition than the therapeutic skills needed to support a deteriorating terminally ill patient. However, I know that if I ever suffer a debilitating, irresolvable injury, I will want to be viewed as a complete person to be helped, not a damaged object to be pitied. I look forward to becoming the type of physician who will provide this same respect to my patients.