Reconnecting

It was my first time interviewing a patient. Standing outside the room, I ran through OLDCARTS in my head, the acronym I had recently learned to elicit the details of a patient’s history of present illness. After three knocks on the door and my well-rehearsed introduction, I was sitting face-to-face with the patient. He looked frail in his wheelchair, slumped and uncomfortable. He was barely able to communicate, though I couldn’t discern whether it was due to a language barrier or his discomfort. His daughter sat calmly in the chair next to him, though her furrowed brow let on more tension than her voice initially did.

In response to my “what brings you in today,” my patient’s daughter provided a list of problems necessitating the visit. I hadn’t been prepared for multiple present illnesses, but I did my best to keep cool and worked methodically through each one- leg swelling, shortness of breath, difficulty urinating.  Though I kept my professional composure, I felt next to useless. I was gathering information though I had only a few weeks of clinical background with which to interpret it.

A few minutes later, my attending walked in the room and jumped right into asking questions with an ease that made her decades of experience evident. In that moment, I felt relieved that the responsibility I temporarily held for this patient’s care was placed in more competent hands.  It didn’t take long for the attending to decide to send the patient to the emergency room. After a call downstairs to the ER, the patient was quietly wheeled away by his daughter.

Two weeks later, when I returned to clinic slightly more equipped than the time before, I followed up with my attending about the patient. He was transferred to the ICU, subsequently aspirated, and was unable to be resuscitated. In an instant, I was faced with mortality in a way that I had not, and truthfully am still not, prepared to confront.

The first feeling was an overwhelmingly guilty one. Was there anything I could have done to have changed the outcome? Should I have been able to recognize the patient’s distress? Was this indicative of my future career in medicine?

The next feeling was guilt for feeling guilty. This wasn’t about me. Did the patient suffer in his last moments? How was the patient’s daughter doing? Did his family members get a chance to say goodbye?

In the first year of medical school, with my head deep in textbooks and lecture slides, I have sometimes found myself disconnected. While studying, my focus often turns inward. Am I going to be prepared for the test? Do I need to study this more? Is this important for me to know? The pursuit of competence and technical skill can be consuming. With mounds of material to plow through, it becomes all too easy to memorize the facts without relation to the patients for whom I joined the profession. I know that heart failure with preserved ejection fraction is a diastolic dysfunction in which the ventricles cannot fill completely but the stroke volume is a normal proportion to the end diastolic volume. But what does that mean for patients, their quality of life, their aspirations, and their families? This is where I have felt the disconnect. This is why, when hearing about the patient who succumbed to heart failure, I thought of myself before the patient or his family.

With medicine comes suffering that affects patients, their families, and their healthcare providers. As a future provider, I have spent time thinking about how much I should be affected by the illnesses of patients. On one end of the spectrum, taking on the full burden of each individual patient will leave a physician overwhelmed, taxed, and possibly unable to make the best decisions for care. On the other end, without taking on any burden of patients, a physician will lose understanding of the human element of patients that has a very real impact on their state of health. So, where on the spectrum should I be? How much of an effect should a patient’s challenges have on me?

Until I spend time on the wards in my 3^rd and 4^th years, I can’t say for certain where I eventually want to fall. For the time being, what I can do is make a conscious effort to remember the patients behind the disease process. I want to actively work to balance competence and compassion. Adding a human element to my studies will guide me to becoming a more humanistic doctor while also solidifying my understanding of the science. Thus far, shadowing and volunteering have been two ways to bring the importance to life for me. During those experiences, I have moments where I feel at ease knowing that this profession has immense potential to truly help people live fuller lives. The moments that remind me why I came to medical school in the first place bring a sense of purpose, determination, and ultimately, connection.