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.
I am still on Cloud 9 to be a contributor to After Rounds. I’m not enthusiastic only because this is my first recurring editorial role since my undergraduate career; I am enthusiastic to be part of a space where conversations for medical providers is not just limited to how to excel in the hospital. We engage frequently in conversations about burnout and wellness – in a way that is actionable. I’ll share bi-weekly (on this space) my recent contributions to the space.
For the past few months, I have been close-lipped about a new opportunity. I received an email in the fall from a recruiter – who was hoping to find contributors to a new digital media space produced by Wolters Kluwer for medical students, physicians-in-training, and attending physicians. I’m so excited to announce that today is launch day for After Rounds and to share my first published article in this space. I feel quite fortunate to have a recurring paid editorial gig so early in my career. Feel free to share your thoughts in the space.
So ERAS is submitted and it’s time for interviews. What a flurry of travel, deep conversations with interviewers and co-interviewees, and excitement. People told me interview season would be the most expensive vacation I would take. It was…expensive. It did not necessarily feel like a vacation. As many of y’all know, I completed a four year MD/MPHTM program and had to complete five tropical medicine courses alongside rotations in the fall semester of my fourth year. Scheduling interviews around my laboratory schedule and my examinations led to two weeks of four interviews per week. Please do yourself a favor and schedule your interviews in a way that is not completely tiresome. Okay let’s jump into it.
Check out the rest of this guest post (that is appropriately timed given that this is interview season) at Surviving Medicine.
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.