A third year student talks about a patient and his family

I admitted a man who thought that he was coming in for a simple infectious disease and only a few days later found out that he actually had metastatic melanoma and wasn’t going to make it more than a few months, if that long.  It was quite the surprise for the patient and his family and quite a surprise for the team based on his presentation.  During his hospitalization, I was able to really get to know the family.  Each day, the wife would bring old pictures of the family to show me and the son would give me a hug as he walked out of the room.

One night, we had a lot of trouble with a cross-cover resident not taking care of pain for this patient.  It was nice to be able to quickly assure the family that that wasn’t ever going to be a problem again.

One evening, I was the last member of my team in the hospital, and I felt the need to check on this patient before I left because I knew that this might be the day he was going to pass away.  I arrived to find him dead.  He had apparently passed away about 2 minutes before I walked up the stairs.  I spent some time with his family in a conference room and then noticed that the nursing staff were preparing his body for the family to view.  I was able to go in and help pull out all the tubes and IV’s and do everything to get him ready, and then it was noted that the body was supposed to be donated to science.  I was totally humbled by this, and the family was overwhelmed, but it was just more evidence of how neat of a guy this was.

 A third year student talks about a family meeting for a patient who is terminally ill

His son and wife were there as well as another son and his wife and four other family members.  They hadn’t really come to terms with the fact that their father was dying, the oncologist hadn’t really given them information about the patient’s diagnosis, and they were really uncertain about how sick he was.  We told them it would be a good time to let other family members know, and then we talked about Hospice….

The amazing part was that the questions were directed at me.  It was my most major experience in being the doctor and taking ownership of my patient.  I was the member of the team who was most in communication with him and his family.  It just turned out that way, and the resident allowed me to have that space, and I felt comfortable taking it.  The resident’s recognition of it afterwards was key.  He gave me credit and told me that I did a fantastic job.  That day, I felt a tremendous amount of responsibility.

Our team really, really gelled.  I was treated as an equal member instead of just being an observer.  Medical students, if given the opportunity and encouragement, can have an integral role.  On the wards, the medical elements may be less important than the feelings, and that is where medical students can contribute.  There is always an emphasis on diagnostic tests and labs and differential diagnoses, which is all extremely important; but, there is less of an emphasis on the doctor-patient relationship and on how to communicate with patients and their families.  A patient’s not just a person lying in the bed, and I think that’s really important to always remember.

 A third year student talks about a great attending

As a 3rd year student, you are always scared of getting pimped, being asked questions and not knowing the answer.  When I was in the intensive care unit, I had a great attending who would get the whole team together and then ask every member of the team questions.  He would go around in a circle so that every single person had to answer and by the time you got to the end nobody remembered who was right or wrong.  Then, he would tell the answer without acknowledging that anybody was right or wrong.  When I didn’t know the answer, I would sometimes try to think of something that would help people laugh because you tend to get a little bit downtrodden in the intensive care unit when a lot of patients don’t do very well.  When you are working with a group of people that are happy to be there and are very supportive of each other and can laugh together, it makes the whole thing worthwhile.  This attending made me feel smart.  Even when I said the wrong answer, he made me feel like I had contributed.  It didn’t even feel like work…

 A student writes about an extracurricular activity

During first year and the summer after first year, I worked in the Childhood Obesity Clinic.  It was a fitness clinic and nutrition clinic for overweight kids in the community.  When they came, the kids would receive education and also a chance to exercise in an effort to combat their obesity and the self-esteem and other social issues that came with it.  The nutrition component was very interesting.  You would see the kids knowing the correct answers to all of the questions we asked: how many calories are in this, how much fat is in this, is fat better than carbs, are carbs better than protein, which vitamins are in this food, etc.  However, it really seemed like a game to them.  They would go to McDonald’s on the way to the game, then play the game and answer all of our nutrition questions, and then leave and go back to McDonald’s on the way home.  It taught me that it is not enough to give patients information and then challenge them to learn it and to answer questions correctly.  If you expect to help people change their unhealthy habits, you have to make sure they really hear what you are saying, understand the significance, and buy into the idea.

In addition to this valuable lesson, I also learned tremendously powerful lessons by playing games with the children after the nutrition sessions.  One day, we played football with two mixed teams of medical students and clinic participants.  There were several very bright, very motivated medical students who wanted to help these kids and several very, very overweight children.  Watching the game, you could see that these kids had never had a chance to really interact in a physical way with their peers.  It seemed that they wanted the opportunity but had not figured out how to obtain it yet. 

I remember very vividly one particular play in which I threw a touchdown pass to one of the little boys.  He was a 12-year old kid who was probably about 4′ 5″ and extremely obese, and it was remarkable to watch his eyes light up as he caught the ball, turned, and ran down the field with medical students following after him.  They were not necessarily trying to outrun him, but they gave him the chance to compete as he ran all the way down the field.  When he scored the touchdown, he did a little victory dance and really celebrated.  It was wonderful to see how much he benefited from what he was able to do and feel.  The physical experience during our games was probably more valuable to these kids than any of the nutrition instruction.  I am happy to say that I think my classmates and I have continued to remember this lesson, especially during our clinical years.  There is much more interacting than lecturing when we are learning from each other, and this is also true in our patient relationships.  I think it’s really a wonderful thing to see.

A student, after a home visit, writes about the patient and his website

I read through Professor N’s notes on the eye, and they were beautiful. [Retired, and slowly dying of pancreatic cancer, Professor N used to teach a course on the physics of the body.]  It was evident that he exerted a great deal of love, care, and attention to detail in preparing these notes for his class.  Even for a non-physics student, his notes were easy to read and well organized.  He included a number of interesting factoids and fascinating optic phenomena that helped to make the text anything but dry.  My favorite component was his diagram illustrating the blind spot.  When we went over this concept in class, I was skeptical.  I would sequentially cover each eye, unconvinced that in isolation either eye was lacking in its perception of part of its respective visual field.  However, after testing my eyes on Dr. N’s blind spot diagram, I was finally sold.  Furthermore, the figures he had selected were colorful and well laid out and, combined with a simple yet elegant font, formed a wonderfully appealing visual aesthetic that required little education other than an appreciation for beauty.  As I read through the lecture, I felt a strong conviction that it was prepared by a person who loved life, someone who had a true passion for learning and teaching.

 A student writes about OB clinic

The sky was a pristine cold blue, and the temperature made me cross my arms as I walked across the hospital parking lot to the obstetric office for my afternoon in clinic.  It had been thirteen months since my last birth working as a doula, and I was excited to be with pregnant women again.  I was handed my first chart of the day, and my preceptor gave me the one line summary of the patient: “18 year old G1P0 at 35 and 6, no issues, here for her prenatal visit.”  I opened the chart, quickly glanced at the patient’s blood pressure and urine dipstick results, and made a mental note about them being normal as I walked down the hall. 

Stopping at the bright blue clinic door, I knocked gently.  Inside was a small-framed Hispanic woman, with a belly that looked as though it was just as much in control of her balance as she was, seated on the exam table.  She had a short hair cut and one gold tooth in the front of her mouth.  Her boyfriend sat in the chair beside her and looked at the floor.  I washed my hands, introduced myself as a medical student, and sat down on the stool.  “How are things going?” I asked. 

She excitedly showed me where she was feeling kicks and told me that he liked to move every time she lied down.  Then, with hands that look like they move with more experience than they actually possess, I began feeling her melon-shaped belly.  I felt a firm, round mound slightly left of center and followed it down to a point just above her pubic bone, hoping that I would actually be able to tell whether or not a head was there.  I breathed a sigh of relief when, more due to her small frame and less due to my skill, I felt a round hard shape between my thumb and forefinger and confirmed the baby’s vertex presentation.  Then I pulled out the measuring tape and explained that the length of her belly should be close to the gestation age in weeks.  I began to get lost in facts I needed to review later when she interrupted my thoughts with another question:  “So, how big do you think my baby is?”  We launched into a new talk about how big babies usually are and how much they grow, and I was very glad to be able to rely on some of my knowledge from previous childbirth educator training.

Then came the moment of every prenatal exam when I hold my breath.  I felt confident that I should be able to find fetal heart tones on this patient, but I knew that if for some reason I did not find them it would leave these parents-to-be in panic until someone who could find the heartbeat arrived.  I set the lavender probe halfway between the patient’s protruding belly button and her blue jeans and applied more sonogram jelly than I could ever possibly need.  Immediately, a loud heartbeat filled the room.  I let out a quiet breath that I had been unconsciously holding.

As we ended the visit, I returned to the stool so that I could sit and talk to the patient.  Once her questions had been answered to the best of my ability, but not with the precision that she would have liked, I left to find my preceptor.

When I returned to give her the next appointment slip, I again asked if she had any other questions.  She looked at me and with a sincere voice of gratitude said, “You are a great doctor.  Thank you for explaining things to me and answering all of my questions.”  She had no idea how my heart soared when I heard her words.  There was nowhere else I would rather have been at that moment.  She didn’t just think I was kind; she thought I was a good physician.

 A student writes about one of the housekeepers

My story is not about a patient or a teacher or a fellow classmate.  It is about a woman named Pat who is one of the housekeepers for Jordan Hall.  I can find Pat most evenings and even some late nights in one of the quiet halls of Jordan cleaning up from the day’s activities.  She is often the only person in the corridor, and she always breaks into a smile when I stop to say hi.  I know she doesn’t know my name, but she recognizes my face.

Usually, I run into Pat when I’ve had a long day and I’m in a hurry to get home.  She is my reminder that I should always make time to say hello and to check in and see how life has been treating the people who frequent the same maze of medical buildings day in and day out that I do.  Our lives are very different, yet we both have family that we miss when we’re at work, we both feel tired at the end of the day, and we both are trying to make the world a little bit cleaner, healthier, and happier.  Pat could easily be a woman that I briskly stride past in the hall on my way home instead of a person that I make a point to greet.  I am so glad that I stopped to introduce myself and chat one night during my first year.  In a very simple way, this woman has taught me much about the power of human connection.