She was nine years young with a complicated diagnosis — neuroblastoma/pheochromocytoma. “Medically interesting” is the term I used as a euphemism for “I am terrified to be involved in her care.” After all, she was dying. I knew that. The team knew that. Her father refused that.
Still now I wonder, did she know?
A week later, I was in Iceland: far from PCAs, codes, and secret tears in the call room. I opened my laptop in the airport on my way home to update her discharge summary (after all, I was delinquent). Signed, just two days prior, was a completed death summary. I read it. I read every progress note. I looked through her vitals. I looked through her laboratory studies. Her imaging. I shut my laptop and boarded the plane.
I cried on the plane. The stranger who sat next to me asked me what was wrong and I said I was afraid of heights. She held my hand until take-off.
Later that evening, I found myself in my apartment complex elevator – it stopped on the 6th floor and I rolled my eyes. One floor away from my apartment. He, the father of the patient who occupied my thoughts on the duration of my flight, walked into the elevator.
“Hello doctor,” he said.
His eyes were bloodshot.
“Hello,” I said. I shifted my weight side to side; the space felt heavy with uncertainty and discomfort.
We reached my floor. “Goodnight” he said.
I rolled my luggage behind me. “Goodnight” I whispered as the elevator doors closed. Still now, I think about the words left unsaid. In the hospital, we used Google translate to navigate the divide between English and Arabic.
How do you say I’m so sorry for your loss in Arabic? And would that even be enough.
We were sitting across from one another in my call room when you asked, “how does it feel to spend a month doing what you believe is your calling?” You’ve always been that way – getting straight to the point. Our conversations of substance are why I tell people that you’re one of my residency big sisters. My answer: “I’m tired.” Fatigue of unspecified etiology, likely multifactorial with at least some emotional component.
“Okay so? We came here to work hard. If you want to be hot at this job…if you want to be brilliant at what you do…forget tired. We’re chasing our passion.” You’ve always been that way – dispensing tough love when I want a hug and ice cream. You’re always right.
“And it’s a privilege, I know. I feel an indescribable amount of gratitude to be on this journey,” I said tentatively.
“Residency teaches us to bemoan what makes us good. We gotta snap out of it. Challenges make us better. Sleepless nights mean we are learning. Don’t whine about not being a white cloud. Be grateful.” You answer your ASCOM: someone wants you to push TPA. I answer my ASCOM: someone wants me to assess a kiddo with altered mental status.
I thought about what you said as I spent the rest of my call awake. I thought about what I described as the hardships of this month: the patient turnover, the acuity, the loss of a patient I loved, the painful conversations during which “I’m sorry to tell you, we don’t anticipate a cure” was dropped, the moment when I held the hand of a child soon to pass and she smiled, the moment when a patient having received a diagnosis of lymphoma paged the overnight nurse to ask me to stop by for “girl talk” because she needed a friend (I can’t blame her), and the moment when a patient in excruciating pain pushed her PCA for upwards of 400 times and then reached for my hand and wept.
One of my attendings said it best: “you’re the type of human who feels everything deeply.” I nodded. She was right. It’s why I danced with a patient’s parents when he was approved for an experimental study drug; it’s the same reason why I cried next to them when he coded. It’s the reason why I say nothing when parents yell; it’s the reason why I again say nothing when they apologize in the light of day. It’s the reason why I went to say goodbye to all the patients I cared for before I left the floor. I saved my favorite (and I know I shouldn’t have favorites) patient for last.
“Hi, I just wanted to say goodbye because it’s my last day on the team.” She teared up, her mother teared up, and I (naturally) teared up as well. “I want you both to know
it’s been such a honor to participate in your care and to walk alongside you during this journey.” She reaches out to hug me. She’s an early adolescent with the hopes of becoming a physician. She just finished her first day of chemotherapy. She wept (I can’t blame her) when she received the diagnosis of stage 4 cancer. I wept (can you blame me?) after we told her. “You’re a really good doctor,” she says. She doesn’t know that I’ll replay these words again and again. “You’ll be a good one too.” She beams and I question what I said – there’s a fine balance between being hopeful and ludicrous. Now rested, I think I may have toed the line.
“How many years left in your training?” her mother asked. They wanted all the details: where did I see myself in five years, how did I get here, and how proud is my family? We remained in silence for a few moments before I collected my belongings. “Thank you so much for everything you’ve done for me. I’ll never forget you.” To which her mother followed (in the typical West African fashion) “continue to work hard and make us proud. We will pray for you.”
To the patients who challenged me, thank you. To the patients who encouraged me, thank you. To the patients who became like family to me, I’m forever changed. Thank you.
I like to believe that words can be likened to sutures. That the turns of phrases that we use to deliver unfortunate diagnoses and prognoses can be restorative, healing. I like to believe that the moments we spend at the bedside to listen, to share, and to learn are important.
I don’t like the emergency department. I didn’t like it as a medical student as I weaved my way between residents and attendings who ran through the pods with ultrasound probes. I didn’t like it last month as a first year resident as I worked my way toward room 45. Per chart review: 13 year old presenting after a syncopal event. Per observation: she was wearing glasses that were pretty cool (which I told her) and a bulky sweatshirt. She was incredibly tall (which I told her was an amazing thing) and incredibly reticent.
For those of us participating in the NRMP match, today is a big day. Scrawled in all capital letters in the box attributed to February 21st is “submission day.” In other words: rank lists are due. It’s crazy to believe that in less than a month, we’re going to find out: if we get our first job in medicine, whether or not we will have to move, and if we need to invest in a new wardrobe (like omg winter coats?). Pre-match anxiety is real (beyond real) and I’ve found myself re-reading my personal statement when I need a dose of reality, when I need a reminder of why I’m letting an algorithm decide my future, or when I need a source of motivation.
Some of you guys have reached out with questions about personal statements. My response: write something incredibly honest. There is no right way to approach your personal statement. I wanted to share a version of my personal statement with y’all. To all the fellow fourth years, hang in there my friends!
This time last year, I had a patient encounter that humbled me. This patient, let’s use a random name (I’m partial to Charlotte), presented to the clinic with a complaint of breast pain. I wrote about this patient encounter – so I don’t want to provide too many details here – and submitted my piece to the Gold Foundation. I felt extremely lucky to have placed 3rd in the Hope Babette Tang Humanism in Medicine Essay Contest. Now, I feel extremely proud to see my essay in this month’s issue of Academic Medicine.
Click on the image below in order to read the piece. Feel free to share your thoughts with me!