A student talks about a trisomy 21 patient’s mom

A.’s mom was incredible, but motherhood hadn’t always been predictable or easy for her. A., her eldest son, was born with trisomy 21. She hadn’t been prepared for this and neither had her husband. But the two of them had risen to the varied challenges of supporting someone with Down’s: making sure that their son received the best possible education, finding babysitters who loved caring for him, encouraging him to help out around the house, discouraging him from spending too much time playing video games. They taught him how to be a committed employee and hold a job. They guided him as he developed the skills he needed to be independent.

Our class had plenty of questions for A.’s mom. We were curious about her son’s diagnosis and his parents’ initial response when the doctors gave them the news. We wanted to know about the medical problems that patients with trisomy 21 would need our help to manage.

On the opposite side of the room, Michelle raised her hand. “What will happen when A. falls in love?” she asked.

A.’s mother’s face broke into a comfortable smile. A. had already fallen in love, and then she talked about his girlfriend, J., how her son spoke with this young woman on the phone in the evenings, patiently and gently, calming her down whenever she’d had a bad day.

I found myself thinking about this interview throughout the afternoon. I was grateful for Michelle’s question and felt fortunate to be learning the practice of medicine among colleagues who see beyond diagnoses to the unique beauty of individual lives. I was grateful to be reminded that anyone can fall in love.

April Bernice, our first patient.
We never met, but were intimate.
You helped us uncover and let us follow
The paths of nerves and the curves of flesh.We got under your skin and into your head, even warmed your heart,
But we missed the woman inside it all.

Did your vocal folds once sing, or your hands once create?
Once upon a time, whom did you comfort and love?
What memories of you survive with grandchildren?

We learned from sights and sensations of the body
Without knowing anything about you as a person
Except that you had made the decision to teach us.
For that, we – and our future patients – thank you, dear April.

We know not of your life’s struggles or joys,
But we know your teachings live beyond your life and into ours.

A student talks about a pre-op interview 

We had only five minutes. Mrs. M needed to go in for yet another surgery, so an interview by first year medical students was not exactly priority.

“Let’s figure out which questions are necessary,” suggested my POM-1 classmate. I agreed. We established our plan and went in with “what brought you to the hospital?” and “what is the purpose of this surgery?” on the tips of our tongues.

“Why hello…I’m so glad you’re here!” The cheery voice and smiling face did not fit with our mental picture of the pre-op patient. “Would you like to see pictures of my family? They’ve been around the world.”

Still surprised, but intrigued, we looked to the nurse holding the photo album. “It’s true,” she said, and noticed our quizzical looks. “Mrs. M is such a great patient. She’s a miracle, really!”

Mrs. M laughed a little and said, “You all have been wonderful, and God has been watching over me.” She pointed at the religious pictures posted on her hospital room wall. She had been here for awhile. “I have been so blessed. My car accident was days ago. But my CNS was completely spared. It’s about all that was spared, but thank God!”

She looked down at her foot, the objective of today’s operation, and went on to tell us of previous surgeries on her legs, arms, and abdomen. By this point, our questions didn’t even matter. The peaceful Mrs. M was soon wheeled out for surgery, but we stayed in her room for a few more minutes. We had most of the story, but needed more time with her pictures.

A student talks about the Social Issues in Medicine course

During my first year of medical school, as part of the Social Issues in Medicine course, I had the privilege of working with UVA Patient and Family Education in a project that focused on helping individuals at risk of not being able to keep track of their medications. These individuals were usually, though by no means exclusively, elderly and situated in places such as senior centers and nursing homes. Many of them suffer from memory-impairing diseases such as Alzheimer Disease. I was assigned the task of distributing small ed cards designed to list all medications one takes, as well as other important information such as resting blood pressure, cholesterol level, and even emergency contacts.

The majority of my weekly visits to these senior centers took place in Charlottesville, but on one occasion I was asked to visit a small center in Nelson County, located about an hour south of Charlottesville. The drive was long, but the scenery undoubtedly pleasant. When I finally arrived at the center I was amazed at how hidden it seemed, located after a series of turns on very small roads. It did not help that I felt like an outsider and that I arrived 20 minutes late, especially since the seniors at the site and the staff were waiting for me to give a presentation. I asked myself if they would even care about the issues I was to mention, and did not want to be perceived as lecturing them.

The visit turned out to be one of my most rewarding experiences of my first year. Both the seniors and the nursing staff at the site were more than eager to obtain med cards to keep track of their medications. I also was able to help fill out the med cards of two elderly women that were unable to read. I was further captivated by how much they expected me to know and their expectations of how much I could teach them, especially concerning detailed questions about their medications. Being only a first-year medical student, I had virtually no knowledge of pharmacology, yet for them I was the doctor and found myself constantly reminding them that my knowledge was extremely limited, and that I was there simply to distribute these med cards and help people keep track of their medications. The experience was thus rewarding in how much they appreciated my presence there, and also humbling in how much I realized I have yet to learn. Then again, the latter point is a part of the routine in med school.

A student talks about staying in the moment

The first patient that ever hugged me bit me first.

She wasn’t even my patient. We had been paired up in teams of two in POM to do our last patient interviews of the year. I had already interviewed my patient, but I was also supposed to observe my partner’s interview.  When we walked into the room the patient was crying. The nurse, standing over her, said “go ahead and interview her now. It’ll take her mind off what I’m doing.”

The patient had a traction device bolted to her leg. She had staples snaking from below her knee all the way up her thigh. It was time to remove the staples. I had never seen anything like it. “You can interview me,” she said to my partner, and then, looking at me, “but only if she holds my hand.”

The patient answered questions through gritted teeth, squeezing my hand until I could hardly feel it. After a particularly deep staple, she turned her head toward my hand and chomped down as hard as she could between my thumb and index finger. At that moment I had some idea of how much pain she was in. Her bite brought me back from my thoughts of how cool the traction device looked, of how amazing it was that they were able to use a vein from her leg to save her foot, of how one wrong step on some rocks could leave you in a hospital looking like this. It brought me back to her: a 50-year-old mother of grown children, who had already spent two weeks in the rehab hospital, getting staples pulled out of her leg without any family around to comfort her.

“I’m sorry,” she said. “I’m usually the one that has to tell my grown kids to stop being such babies. If they could only see me now.”

When we finished the interview, she hugged me and thanked me. I hugged her back. She needed my hand. I needed her bite.

A student talks about anatomy lab

Boobs or butts? This was one of the very first questions my anatomy lab group discussed…in detail. It was the first day of our cadaver dissection; all of us were pretty nervous (one of my lab mates and I were even talking about techniques to avoid passing out….just in case we needed them…..which we didn’t…because we were awesome); consequently we were trying to distract ourselves before we started our first series of incisions. The conversation began when the girls in our lab group were discussing what physical features they liked on a guy (an appropriate discussion in an anatomy suite); muscle, abs, chest, etc etc. Naturally, this sparked a conversation among us guys as to what constitutes the perfect female physique.

It was an interesting icebreaker. Now that we had our minds focused on anatomy, the first incision was cake. The rest of our work in the anatomy lab was stress-free (at least I think it was; I’m still a little foggy from the formaldehyde).

A student talks about a nursing home visit

During our POM class last fall, we had a day scheduled to go to a nursing home and meet the residents. I was particularly busy that week and remember grumbling throughout the day that I had to spend time in the nursing home that afternoon. When I arrived at the nursing home I was introduced to an elderly woman who had been there for over 20 years. The nurse told me that the woman had straightened her room all morning (while I was grumbling) to prepare for my visit.

The visit lasted longer than scheduled. A nurse had to ask me to leave. The patient and I had laughed for over an hour. She had a lifetime of great stories to share. She was visibly upset when I had to leave and asked for my cell phone number so she could call me up and invite me to lunch.

While just a bullet point in the schedule of a busy medical student, these visits can be important occasions for lonely patients. For me, this was the most powerful moment during the first year of medical school. It drove home the lessons we were taught during POM-the “human” side of medicine should be just as important as the science. And fun.