A Work in Progress

My second rotation as a third year medical student was internal medicine. Unlike my first clerkship, family medicine, internal medicine focuses on the inpatient side of patient care.

I arrived a little before 0600 on my first day and was told to select a couple of patients written on a white board and “go for it.” The freedom was simultaneously exhilarating and terrifying. There was no choosing wisely, there was simply choosing. I looked at the last names written on the board. With shaky hands and a squeaky green dry-erase marker, I wrote my initials next to two patients while thinking to myself, “What wonder is waiting for me after this?”

I approached the first room dressed in my short, pristine and pressed white coat. I was going to gather the best history and physical.  The door was cracked open and with a quick double tap on the door, I awaited permission to enter. A raspy voice came from the dark room, “Okay, come in.”

I entered the room, introduced myself as Christina, the medical student, and asked permission to turn on a light. When I flipped on the light, I saw him. He was 5’10” and only 38.5 kg (85 lbs). Never in my life had I ever seen someone so cachexic (emaciated). I pulled up a chair next to him and asked if he would be willing to share his story with me.

He previously worked 12 to 16 hour arduous days in a home remodeling construction job without health benefits. The work was so incredibly physically demanding that one day he simply could not get up and go to work.  After losing his home, he was able to make a deal with another company remodeling an abandoned apartment complex. In exchange for helping remodel the complex, he was provided one mayonnaise sandwich per day and a place to sleep under a cement staircase. His one friend checked on him every day and began to notice him withering away. He became more and more frail until one day she told him, “Enough is enough”, and called an ambulance.

This homeless man had been unable to provide himself enough nutrients to survive, let alone basic aspects of hygiene. He had long hair, a long beard and long, sharp, fungal-infected finger and toenails. After interviewing and hearing him share his story, it was clear to me he was in great need of attention and care.

I stayed late, after our rounds were over for the day, and returned to the unit to ask the nursing staff if they carried any fingernail clippers. I was handed a package of surgical scissors. I spent time delicately trimming his nails while continuing to learn from him and listen to his story. After I finished, I told him to order himself a good dinner and that I would see him bright and early the next morning.

He grabbed my hand as I was turning to leave and said, “I’m sorry. I am such a mess.” Embracing his hand and thinking on his comment, I replied, “No. You are not a mess. You’re just a work in progress.”

Over the course of the next weeks, I watched as he was able to gain his strength back. I watched him gain the ability to take over his own hygiene and to turn himself in bed. I watched as he was able to go from laying to sitting, then from sitting to standing, and finally from standing to walking. I watched as he left the hospital.  I will never forget him. He reminded me to always keep humanity at the forefront of my medical practice because we’re all just a work in progress.