It’s okay that you don’t remember me. My name is Shara, and I’m part of the surgical team. I’m checking to see how you’re doing after your surgery.
Do you know where you are right now?
Actually, you’re in the hospital. You had surgery a few hours ago, for a broken hip. You used to be able to walk before you broke it, so it was important to fix it as soon …
There was a very large lesion in his left frontal lobe, and no one knew what it was.
He had been admitted earlier that day, after a neighbor found him in the hallway, confused and covered in urine. Now he sat in his bed quietly, while we stared at his brain and the bright spot that didn’t quite resemble something.
It can’t be tissue death from a stroke, insisted one resident. It …
I saw my intellectual exercise as something I hadn’t before
On my second day of fourth year, I had to make a decision.
“Mr. K would like Miralax,” read the nurse’s page.
A medical sub-internship, which a student completes in her fourth year, is designed to be an internship with training wheels. The main difference between third and fourth year is that the third year reports to an intern (who makes a decision) while the fourth year replaces the intern. Last year …
Sub-internship: The small stones are under my guardianship
When we told the patient and his family that the mass in his lung was highly concerning for cancer, he didn’t say anything. His daughter asked about his symptoms. His son-in-law asked when and how he could get a definitive diagnosis. His wife asked when he could go home. Finally, he spoke.
“I’m sorry for being so much trouble.” The tone was casually apologetic, …
Our medical education system does not tolerate emotional cracks
“Your hands feel like velvet,” the 94-year-old woman told me as I pushed on her abdomen in the emergency department on a Friday night.
“That’s the nicest thing anyone’s said to me all day,” I told her.
“That’s pretty sad,” she said, and her abdomen quivered as she suppressed a laugh.
I walked out of the curtained room and briefly presented her findings to the resident on call. In return, he showed me …
We hide behind vague words for fear of not living up to specific ones
“You’re not sorry.”
Within two days two different patients said this to me, each with hatred in his voice. Each time I was alone, each time I had known the patient for only a few minutes, and each time the rage was directed at me and only me.
For seven months, I had avoided being the bad guy. When a patient got upset, he accused my superiors, and I hid behind their …
Be the bad guy with good intentions
I pull up a test result for my patient, and the senior resident standing behind me lets out an excited squeal.
“I’ve never seen the imaging come back positive for this,” she says. Our two-week-old infant, who already has a rare infection, also has a rare associated structural abnormality. It’s not benign, but it is fixable. The fix usually requires surgery.
As we walk over to the patient’s room to update her …
When the initial reaction to an unusual test result is happiness
She had only been in the hospital twice in her life: once when she was nine and now, 60 years later. She had gotten tonsils out then. She was getting tumors out now.
Her abdomen hurt when she was awake. Her abdomen would also hurt during exploratory surgery, although she wouldn’t be able to feel it under general anesthesia. Her body would feel it, though, and could respond by dangerously spiking …
How pain control comes from the front and back
“By the way,” my chief resident told me on the first day of my inpatient psychiatry rotation, “don’t lick your lips in front of him.”
“Wait, what happens if–”
I fell silent as the patient walked into the interview room. The resident wanted to discuss his paranoid delusions; the patient wanted to discuss his discharge.
The patient wasn’t ready to leave because the medications that made the demons stay away were also making his …
On the inpatient psychiatry ward, a new code governs
An elderly man startles awake after a man in a white coat touches his shoulder. He looks around and sees three other white-coated people standing around his bed.
“Sir? Good afternoon, sir. How are you?” says the man who touched the patient’s shoulder.
“Oh, I’m fine.” He’s perfectly calm.
“I know this is a silly question,” continues the man, “but do you know where you are right now?”
“Of course, of course. I’m at …
How to steel myself against this profession I have chosen
Impersonal and self-absorbed as Manhattan may be, it’s still embarrassing to cry on West 32nd Street. I looked for a store, any store, and ducked inside. The pace of my steps and angle of my head as I buried myself into a back corner, thumbing through pants twice my size, gave me away. A store clerk walked over and asked if I was okay. I knew I’d have to meet …
When doctors are called providers
His face was four inches away from mine. I tried not to blink as he shined the ophthalmoscope’s light into my left eye and stared into my pupil as though it were the most interesting thing in the world. He frowned, placed his hand on my head, and used his thumb to pry my eyelid higher. He maneuvered for about 45 more seconds while I sat stone still, and then, suddenly, …
Medical school is a fragmented, intimate experience
When the patient jokingly touched my nose, I knew I had muddied the boundaries between us too much and it was too late to go back.
(Note: Except for the aforementioned sentence, all of the patient’s details and quotations have been fabricated. Events from the interview and exam have been drawn from a conglomeration of patients and scrambled to illustrate a general theme.)
It didn’t happen until the end of the interview, …
When easy familiarity blurs the boundaries
Our first assignment for medical school involved reading and discussing Anne Fadiman’s The Spirit Catches You and You Fall Down, which describes how a clash of two cultures (medical and recently immigrated Hmong), miscommunication, and misunderstanding led to tragedy. Poignantly narrated, the book had the take-home message: if a patient does not agree with a physician’s reasoning why a disease developed and how it can be cured, then even the best …
What do you think caused your disease?
I’m starting to understand why graphic pictures on cigarette packs are so effective.
We are studying pathology, which is the human body gone wrong. The photos–taken from autopsies–are gross, meaning their structures can be seen with the naked eye. Cirrhotic livers are littered with bumps and scars, the heart dies and leaves a band of black tissue behind, the lungs are stretched so far that they can’t pull in the …
When learning pathology, real color is difficult to forget
Listening to patients for the past two weeks, we learned quite a bit about what patients appreciated about their doctors and what had left them hurt and confused.
The good:
M., an elderly lady with a very close relationship with her primary care physician, said she had been to many bad doctors in her life. She knew right away that her current doctor …
What your patient appreciates, and what causes hurt and confusion
Doctors vs. nurses (or doctors vs. nurse practitioners, or doctors vs. physician assistants, or what have you). The debate is old, tired, unimaginative, divisive, and wrong-headed–for reasons that are too obvious even to list. Does it get perpetuated because it garners comments (175 of them, to be exact)? Snarkniess is not appreciated by this reader, at least.
The New York Times recently ran a column by one of its editors, “Read more…
Praise nurses without comparing them to physicians
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