Progress Notes

Remembering that patients are human too

It took about eight months of clinics before my first patient passed away. I routinely felt death (and life) passing through the hospital halls as I went through my OB-GYN, pediatric and psychiatry clerkships. I always wondered how I’d react if one of my own patients died. I envisioned a defining moment that would add perspective on what it meant to be a doctor. I expected sorrow and grief; instead, I met only guilt.

I was on the medicine team taking care of a dry-humored, witty veteran. For the past few years, his health had been slowly dissipating. Each morning he’d grumble, “How many times are you going to poke me in the stomach, boy?” Or command, “Cover up my toes like you found them.”

Many tried to minimize their interactions with him, but I sensed earnestness to his demeanor –  he was tired of searching for answers. If there’s anything I’ve learned in my first eight months of clinical duties it’s that each of your patients has an identifying feature.

adult-care-elderly-748780No, I’m not talking about the “the patient with a history of X presenting for Z,” but a personal quality that sparks your memory of the patient. For this man, it was his rugged nature.

He remained largely stable for most of his hospitalization. His hospital stay became more about stalking his imaging and labs than compiling pieces of his medical history.

However, this regularity of the morning pre-rounds was interrupted with unexpected respiratory failure. Vitals were deteriorating. There was fluid in his lungs. We were caught in the too common conundrum of having to manage his fluid imbalance.

We transitioned him to higher intensity care before we could take a breath – he was stable. We talked to the family about his health and re-affirmed his code status. He was willing to accept his condition and did not want the doctors “messing around.” I left that evening after short call worn out mentally and emotionally. I had a patient who almost died.

The next day, I began my daily pre-round checklist. As I was about to click on my patient’s name, I felt a tap on my shoulder: “Jesal, Mr. J passed away last night. He had further decline in his respiratory status and as he had refused intubation, there was nothing else we could do. His family was informed last night over the phone.”

I was taken aback. Despite this knowledge, I went ahead and clicked on his name. I had become so used to hounding his chart for the most recent lab values, the newest imaging reads and the latest updates from consult services. The chase for answers was incomplete but was no longer necessary. It was like I had “discharged” my patient. It was time to pick up a new patient and restart the process of care.

How could those be my first thoughts? I felt guilty of being a robot plugged into a specific pattern of thinking and working that relied so heavily on the EMR. The more time I spent in clinic, the more I relied on the medical charts to learn about my patients. My relationship with patients had gradually become more medical and less human.

This wasn’t how I expected to react after more than two years of medical education. I was supposed to be more humane. I thought the best way to sustain my humanity was by maintaining a well-balanced life or engaging creatively with the larger questions of healthcare. While I worked hard on “winning” these battles, I had lost the most important one of all – how I engaged in patient care.

Despite my reservations, I turned to writing. As I began pouring over my thoughts of the patient, I realized that my memory of all the details of his medical history and hospital course had become fuzzy. I pictured how he’d answer my morning question, “How was the night, Mr. J?” At first, staring silently at the wall, then sighing and firmly looking into my eyes, and uttering a single word, “Good.” I recalled his detest for labs as he snapped, “You people will bleed me dry.”

The most prominent memory left was that of a man that was so very creative in sharing his displeasure for his hospital stay – the identifying personal characteristic of the patient, the triggering feature.

The medical field is so formative in good and challenging ways. The clinical education process so heavily relies on us, as students, to master the efficiency of medical processes and develop our clinical knowledge, but sometimes fails to reinforce our humanity, which is what really allows us to connect with our patients.

The pressures of clinical practice and academic expectations push us in ways not natural for humans, but when it came to it, I didn’t remember Mr. J as a man with X, Y and Z. Instead, I remembered a man who would sneak in at least 10 comments each morning about how being in the hospital sucked. Maybe there’s still hope.

-By Jesal Shah, MS3 at Baylor College of Medicine

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