Flowers and bees.

By no means is that very telling of my current life. On the contrary, I get glimpses of different times of the day when I go into patients’ rooms and look out the window or if by chance the anesthesiologist decides to open the curtains in the OR (yes, this hospital has windows in its ORs!).

So this topic of flowers and bees is very random. But it just so happened that one of my patients is an avid gardener. During the midst of morning rounds, I was struggling to read the nurses’ notes, review lab values and images, and see all my (new) patients before the attending. This morning, I decided to save my most complicated patients for last. So when things finally calmed down a bit (despite an unexpected open wound and hemorrhage that occurred in a patient’s room, which consisted of me running to the ED to fetch suturing supplies), I finally arrived with much relief at the door of my last patient. By this time, it was close to noon, and I was starving. I quickly read my cursory notes and mentally prepared myself to pay close attention to this patient’s most pressing issues.

This patient’s situation is truly a sad one. He has metastatic liver cancer, had undergone a hepatic lobectomy, was discharged, but readmitted due to complications of pneumonia and end stage renal disease. As I auscultated his lungs and pressed on his distended belly, my heart sank. I wasn’t expecting much conversation from this elderly gentleman, but all of a sudden, he said, “she doesn’t know yet, you know.”

I paused.

“My wife doesn’t know the extent of my kidney disease. I have to tell her.”

I froze. Not knowing what to do, not knowing how to reply to something like this. So I just stood there and frowned.

“I had plans for the summer you know. But now I’m dying.”

He looked forlornly into space and fumbled with his blanket. I wasn’t yet ready to talk about dying with this man. So instead, I asked him something entirely stupid.

“What plans did you have?”

“Oh, I was just going to plant some flowers in my garden.”

This reply simply broke my heart. Something so seemingly simple as planting flowers, now seemed like an impossibly difficult task.

But I continued to avoid the subject. “What’s your favorite flower?”

And on and on it went. I refused to let ourselves be caught helplessly in a web’s tangle of despair and hopelessness. So I tried constantly to take his mind off the present.

“I like flowers, but I don’t think I could ever garden. There are too many bees around flowers, and I’m terrified of bees,” I said. It was then that our roles were reversed. He tried to convince me to overcome my fear of bees. But I was unrelenting.

“At some point, you can’t let your fears hinder you from doing what you like. If you like flowers, go outside and enjoy them. Don’t let those bees bother you.”

With this statement out in the open, we just stared at each other for a moment. We both knew that his statement was just as much meant for himself as it was for me.

“You’re right,” I replied, and finished the rest of the physical exam.

Aside from the chaos of trying to navigate different kinds of information and piecing them together in order to construct a (hopefully) helpful plan in a timely manner for every patient I see, there is another side of me that is completely clueless in terms of managing my emotions.

Earlier this morning, I had gone in to see a woman who had her gallbladder taken out a couple of days ago. She was very ill pre-operatively, and she was still in a lot of pain post-operatively. As part of any physical exam, I gently palpated her abdomen. She flinched immediately and screamed in horror. Later during rounds with the resident and attending, she was in tears.

I think I’m sensible enough to know that I was just doing my job and that there was nothing I could have done to prevent her pain. But my heart still went out to her, and I stayed a little longer to apologize and hold her hand.

When I got out, my resident took me aside and gently said, “You can’t be that nice all the time. You have to keep your emotions separate and move on.”

I nodded and smiled sheepishly.

I am aware that physicians have to keep their emotions aside to some extent to not only protect themselves, but also to protect the patients. But as a young, budding medical student, completely new to the wards and all of its stories, heartbreaking as well as heartwarming, I am struggling to find my own balance.

Holly Yong is a medical student who blogs at one step at a time.