The first day I came to the liver service, I met Mr. S, who was struggling with complications of liver disease. In the long term, he required a TIPS procedure that would better distribute his abdominal pressure and eventually a liver transplant. He was at high risk for the procedure and was struggling to maintain the fluid restriction necessary to prepare him for it.
Mr. S was entirely despondent when I met him. He had already been in the hospital for two weeks and couldn’t imagine staying any longer. He missed his home, his bed, and home-cooked meals. He understood the consequences of leaving the hospital—his death—but he couldn’t seem to find a reason to believe in himself.
“This was my fault, doctor,” he confessed to me. “I was the one who kept on drinking, and I have no one but myself to blame for what happened to my liver.”
He showed me a picture of himself when he was younger. Mr. S was a very handsome young man in his prime. “Look at who I used to be. Look at me now,” he said, pointing to his yellow skin and enlarged abdomen, all consequences of his liver disease. “It’s hard to be positive when you’ve fallen so far.”
While I was listening to Mr. S speak, I noticed that it was snowing outside. It had surely been a hard time for him, and the weather was not making it any better.
I resolved to come back later in the afternoon and spend more time with Mr. S.
Later, I found Mr. S despondent again. “I just don’t know if I can do this, doctor.”
Without any idea what else to say next, I put my hand on Mr. S’s shoulder and told him, “I believe in you. I know you can do this.”
The next thing I knew, there were tears in Mr. S’s eyes. “Thank you, doctor. No one has ever told me they believed in me before. Your words mean a lot to me.”
I explained to him that while I believed in him, he would have to believe in himself too. Just then, as if by coincidence, the cloudy sky had begun to clear, making way for dusk. It was a tremendous sight to behold.
I told Mr. S that his hospital course and the challenge he was facing at that moment were like the snowstorm outside. The snowstorm seemed like it would last forever, as if we had forgotten what the sun looked like. But just as the storm would end and the sun would come out, as it did in that moment, I believed that Mr. S could also make it through his ordeal and live a better life after his procedure.
From that day forward, Mr. S seemed like a different person. He was committed to his volume restriction. He stopped eating Italian ice. He was focused. He was moving closer to his procedure each day. On my last day of service, I said goodbye to Mr. S. He replied, “Thank you, Doctor. Your belief in me gave me the strength to see this through. Even when you’re gone, I’ll remember your belief in me.”
Sometimes I wonder how useful I can be to patients on highly specialized services. I have appreciated the journey of learning how to take care of liver patients, but as an intern, much of the management is still deferred to those senior to me. I appreciated Mr. S teaching me that even as I gain the necessary medical knowledge and competency, I still have value to patients like him. Even with all the advances in therapies and treatments, if he were to have lost his motivation and left the hospital, they would have been for naught.
A few weeks later, while on another service, I saw that Mr. S was still in the hospital. I went to visit him. In his room, there were motivational messages written by himself and his loved ones. He had finally gotten his TIPS procedure and would soon be discharged and placed on the transplant list. We beamed and shared the moment of triumph together.
Mr. S had survived his storm and had seen the light at the end of his ordeal. It has been a privilege as a physician to guide patients on that journey. A patient’s path may never be easy, but they should never walk it alone.
Johnathan Yao is an internal medicine resident.
