During my first rotation of intern year, we took care of a woman who walked into the hospital with a kidney stone and never walked out. 52 years old, diabetic but otherwise healthy, she had been vacationing in Vermont with her son and extended family when she became sick with high fevers. When her symptoms didn’t improve, her son rushed her to our emergency room where an imaging scan revealed a kidney stone that was obstructing urine flow and needed urgent removal. Somewhere between the ER and the procedure suite, she suffered a cardiac arrest, likely the result of a severe infection caused by the obstructing stone. When she regained circulation, she was transferred to the medical intensive care unit, where I took part in her care.
Over the next several days, she didn’t wake up to voice or painful stimuli — an ominous sign. Fearing the worst, we got an imaging scan of her brain. The characteristic white and gray matter of a healthy brain had given way to a uniform, homogenous texture that filled the space of her skull. She had suffered a massive, irreversible brain injury that would almost certainly progress to brain death. Her son was 21 years old — an only child — and his dad had been out of the picture for a long time. As far as he was concerned, his only immediate family was his mom.
In medical school, we are taught the anatomy of breaking bad news: Ask the individual what he understands about the situation. Explain the outcome in clear language, free of medical jargon. Express empathy — offer a light hand on the arm, if appropriate. Say, “I’m so sorry.” But can this really be all there is to something as profound as telling a 21 year old that his mom won’t be waking up? In my mind, there had to be something more human to it than this script prescribed by our formal education.
For me, the most challenging part of becoming a physician was trying to understand how to traverse that vast gap between doctor and patient. Or in this case, the patient’s family. What I’ve learned is that effectively showing empathy for another requires me to deliberately reflect on my own experiences.
Several years ago, my grandmother suffered a sudden hemorrhagic brainstem stroke, from which she never recovered. When something like that happens, you take part in the universal phenomenon of having suffered a great, irretrievable loss. You feel that grief deep inside of your bones, your stomach, your chest. It is heavy for a long time. I think that there is much to be said about remembering this aching, actively reflecting back and it, and perhaps keeping the sorrow alive in this way.
When I see a patient’s vulnerability, I am conscious of my own, and I am reminded of that common human thread that runs between us. In turn, I believe that our patients appreciate being able to see that we are also vulnerable. In the end, what our patient’s son wanted to know was that we, too, were affected by his mother’s passing.
Michelle Zhang is an internal medicine resident.
Image credit: Shutterstock.com
