More than just a dischargist: A moment of connection

An encounter with a self-aware patient reminds the writer why he went into medicine.

Striving for mediocrity and the avoidance of creative misfires, I used a fairly formulaic approach to writing my residency application's personal statement on “Why I want to be an internist.”

I began by narrating the tale of how a naturally inquisitive child developed an early love of science and a fascination with the mysteries of the human body. This child matured into a young man who felt the altruistic need to impact the lives of those around him—to literally hold the hands of those suffering and help ease their pain.

Photo courtesy of Brian D Wolfe
Photo courtesy of Brian D. Wolfe.

Similar to a lawyer's closing statement, the essay finished by not-so-subtly connecting the dots so the program director would draw the conclusion that this earnest young man was destined to be an Internist (with a capital “I”) in the tradition of Osler.

Now as I approach the end of my first decade as an attending, I am certainly a more realistic physician and human being. My job as a hospitalist and educator involves helping residents “get out” to satisfy work-hour restrictions, helping my hospital hit its core measures and proving to the C-suite my group's continued value in preventing dreaded emergency department diverts.

With these competing goals and drivers, I presume I am not alone in at times feeling less like Osler and more like a duty-hour infraction avoidist, a rapid-turnover dischargist and a medication reconciliationist. After all, did Osler ever have a house officer say, “Hey Willy, my team is capped, so you need to admit this shooter with a fever”?

This week, though, I was reminded of my residency application essay. I met a far-too-young woman who had undergone an abdominoperineal resection and colostomy of anal canal cancer one year after failing local resection, chemotherapy and radiation. She was admitted to my service with an infection, and shortly after admission I was told that imaging done in the emergency department indicated she likely had a recurrence of cancer. It was 5 p.m. on a Friday.

I knocked on her room door and introduced myself. We talked briefly about her abdominal pain and other symptoms. I then broached the issue of her MRI and what it likely meant.

Over the next hour, she showed me how truly amazing people can be in times of crisis, and how lucky we are as internists to witness these miracles of character. She expressed how angry she was at the return of the cancer. And in the next breath she chided herself for slipping into self-pity, acknowledging it could be worse.

She reflected how days after having the surgery, she had lost her Medicaid through a clerical error, so the home ostomy nursing visit that was planned at discharge never happened. She cried as she told me how disgusting it was when the bag starting leaking and she did not know what to do. She admitted that she had never been able to look at herself as whole since the operation, as she asked without bitterness but instead with regret, “How can someone possibly love me when I cannot even love myself?”

She shared with me how crazy and wonderful her family was, and how they just wanted her to be the happy person she was before her cancer story began. She cried, she laughed, and she willingly exposed her fears, embarrassments and small triumphs.

I would love to write that my knowledge and experience allowed me to offer words that taught her to see hope despite her recurrence, to see herself as a woman as opposed to a person with a surgical outcome, but that would not be the truth. My experience allowed me only to confess that while I have walked beside many patients through tragedy, I could not truly empathize with her plight. The only comfort I offered was to justify her right to be angry and to be afraid.

At the end of the conversation, she thanked me profusely, and told me how much better she felt. What she did not realize was how much more she had helped me than the reverse. She reminded me of what is so easy to forget as a physician. We have an amazing profession that allows us to be present when our patients face some of the most difficult calamities of their lives. They share these personal struggles with us and occasionally we are able to relieve some of their burdens, whether with medicine or simply by holding a hand.