I'm currently transitioning from the boring bookwork part of medical school, into the fresh, exciting life of clinical rotations currently. I've started out on a Family Medicine rotation, and I finally get to start seeing patients now and feeling like I'm actually contributing in the grand scheme of health care. It's a time of excitement, nervousness, and any other emotion you can pack in, especially having to take extra pre-caution in the middle of a pandemic. As I go on this journey, I plan on reflecting on certain patient interactions that I've found meaningful, and writing about them. I hope to share something deep and meaningful (without violating HIPAA laws of course), and hopefully anybody that reads this will get something out of it as well.. so without further ado, here's Tales From The Wards:
Family Medicine is a very fun rotation to begin with, because you see all types of different patients. You have young patients, old patients, serious disorders, and everything in between. Although I'm only on my third week of clinicals, I've already met a patient that will stick with me for a long time. The way the rotation works is that I get the chart from the nurse at the clinic, I review the chart for any diagnostic tests, past medical history, medications, etc. then go interview the patient alone, present my findings to the attending, make a plan and assessment, and then my attending will discuss anything that's relevant in a teaching moment. I'll never forget how thick this patient's particular chart was, I remember thinking, "oh boy, this is going to take a bit of time." As I was going through the chart, the story of this 62 year old man began to form in my head. Reviewing page after page, lab result after lab result, medication after medication, as I was jotting notes down for my patient interview, thinking, "holy hell, this poor guy."
This 62 year old man had been through everything, he has hypertension (high blood pressure), hypercholestremia (high cholesterol), diabetes, deafness in one ear, history of depression, kidney cancer that was removed, immunosuppression (a weak immune system), and was presenting with fatigue and poor appetite. Just going through it played on my emotions, I was incredibly heartbroken for this man, he'd been through so many things, and to top it off the fatigue and poor appetite raised a red flag for a possible COVID infection as well. It seemed that life had really tried to knock this guy down as much as possible. I couldn't believe it, as I prepared my notes, I began mentally preparing myself for a difficult interview. The thing they preach in medical school is to have empathy, however you can't train empathy, you either have it or you don't. They tell you not to get too attached to the patient, because when they die, it takes a major toll. Being so young in my training, I couldn't help but already feel despair for this guy. When would it end?
As I introduced myself to the patient, and began the interview however, it was the complete opposite of what I had expected. This man, clearly in pain and suffering, looking miserable and fatigued, was so genuinely upbeat. All throughout the interview, even explaining his symptoms and history, he still had a positive demeanor. This guy was cracking jokes left and right, and I couldn't tell but for some reason I felt there was a smile under his mask. I couldn't believe how someone who had been through absolute hell, could still share this positive attitude with a complete stranger of a medical student, who won't even be there for his next check-up visit. Even as I told him that he's going to probably have to get a blood test, and a COVID test, he STILL simply agreed, made a joke, and continued on. As I was presenting to my attending, my attending said, "I've had him as a patient for a long time, he has been through every stage of the type of patient you'll see, miserable, hopefully, happy, you name it, but he stuck with happiness, and it does my heart good knowing that."
I think as I reflect, it's amazing to see how life genuinely is in the eye of the beholder. Even being a pretty optimistic person, I tried to put myself in this patient's shoes and think of how I'd feel, and I don't think I could have handled it with the grace and class this man has done. It's proven that positive attitudes in patients, lead to more positive outcomes, we don't know how, and we don't know why, we just know it exists. Now of course, that's much easier said than done, I couldn't have blamed this man for being down on his luck. As I wrote the prescription for all of his medications (14 by the way), I realized, that life will give you adverse events. It's how you choose to respond to them, this man has taken all of the bad things, and found a way to still live his life as best as he can while he's here. I know that it's impossible to be happy at all times, and that bad days are just a part of life. The good days wouldn't be as special if it weren't for the bad days, but with this patient I want to keep in mind that as bad as your situation might be, there is a light at the end of the tunnel. Whether it's enjoying your moments on Earth because life is precious, to absolutely succeeding in all aspects, I'm going to strive to be a positive, upbeat, optimistic human as much as I can be. It will not only benefit me in becoming a better physician, but will benefit the relationships I have with patients going forward. I may not ever see this 62 year old man again after this rotation, but I will hold on to the memory and impact he had in such a short visit. I also know I'm damn sure gonna be rooting for him to live as long and as happy as he wants.