Progress Notes

Four weeks

Maria OtazoBy Maria Adelaida Otazo, MS3

Editor’s Note: All names have been changed and all patient identifiers have been removed from this story.

One of my first patients on Internal Medicine was very much like me: female, Latina and 30 years old. However, there was one fundamental difference between us; she had terminal cancer.  The day that we assumed her care was the day of her diagnosis. When my team walked into the room to offer our support, she was sobbing and holding the Chaplain’s hand as he gently recited passages from the Bible.  My attending leaned in to speak encouraging words to her while my upper level resident kneeled by her bedside.  How could I possibly comfort this woman?  From my place at the bedside, I rested my hands on her ankles and gave them a supportive squeeze.  She looked at me in a stunned, tearful silence, not really seeing me, and not really seeing any of us.

For the first week, every morning she described her fever, nausea and her abdominal pain in intimate detail. Together, we mapped their spikes and fluctuations in space and in time as I gently examined her.

For the second week, fevers, pain and nausea were still the foundation of our interactions.  One morning I was listening to her heart and she touched a ruffle on my dress.  “I love purple,” she painstakingly croaked, “where did you buy your dress?” Unbeknownst to me, she had many questions for me, but not questions that I expected: where was my family from? Why did I have a strange accent when I spoke Spanish? How did I spend my days off?

My team knew that her prognosis was very poor. One day during rounds, my Attending pensively and heavily divulged his thoughts: “Once Death has a hold of you, there’s no letting go. And Death certainly has a hold of her.”

That is exactly when I started crying in front of my whole team.  How professional of you, Maria. Several supportive words and hugs later, I was composed but still shaken.

During the third week, I entered our patient’s room one fateful morning to find her making a collage.  She bemoaned her inadequacy at drawing and cutting out stars, and politely asked for help. I put away my scribbled notes, sat next to her on the bed and summoned all previous artistic training in order to draw a star. She watched intently with her Bible open in her lap as I cut out the star.  Afterwards she handed me a purple marker and asked me to draw another, and my reward was hearing about how she had met her boyfriend of 2 years.

I cried every single day during morning rounds that week when I tried to present her to my team.  Knowing that she did not understand how little time she had left to live devastated me. Much to my surprise, I was met with overwhelming support.  During my most obvious and messy crying fit, one of my Attendings told me that the moment I stopped feeling for patients was the moment that I needed to find a new job.

By the fourth week, our patient was finally ready to go home. When we said goodbye, she cried and clung to me.  We both shared the tissue box.

She passed away recently.  I remember how, despite how awful she felt, she still looked beyond her own suffering in order to make a personal connection with me.  I remember drawing imperfect stars for her. I remember discreetly dabbing away my tears in hallways and hoping that nobody would notice.  I remember my incredibly supportive teams. Above all, I remember feeling. My feelings were unpleasant and painful, but rather than preventing me from bonding with the patient they propelled me towards it.  If only she knew how much our interaction meant to me.

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