2014 Annual Competition Winner -"My Patient"

By: Kelsey Bryant

My Patient

It was a Saturday night after a long call day on the medicine wards. My team and I made it through the day on watered-down coffee from the hospital lounge and a pile of snack food to which we had all contributed items that were equally unhealthy.  We reached our quota for new admissions, and the plans were put in motion. Things had finally quieted down. It was one of those days where the beginning and the end blurred, when you step off the ward surprised to find another day has passed and everyone else has carried on—business as usual. It was my last day after three weeks on the service, and I felt I could not leave without first saying goodbye to one particular patient.

A young woman, just a few years older than I, was on our service for the duration of my rotation. Perhaps it was her cheerfulness in the face of illness that drew me to her. Maybe it was her patience as medical teams consulted one another, changing her treatment regimen every few days. Whatever the case, the time I spent caring for her left a lasting impact.  A hospitalization incited by a complex trauma, she had been on the medicine service for about a week by the time we met for post-op management of her antibiotic regimen, pain control, and a case of nosocomial pneumonia.

I always saw her last in the mornings; I wanted to ensure no patient went unseen and it was inevitable we would start to chat. We talked about life before and after her accident, about family support and the unfortunate lack thereof. A result of her extensive injuries, my patient was no longer able to care for her three young children. We discussed how difficult it was for a previously healthy single mother to go from acting as their sole caregiver to being incapacitated in a hospital bed. Each day, the story unfolded as she shared more details of her life and how she came to be the person sitting before me. Though happy to be recovering from a previously grave prognosis, she was still quite fragile both physically and emotionally.  

No longer requiring critical care, her remaining medical problems were not especially complex. However, her words taught me more about the practice of medicine than studying treatment protocols in a textbook. She reminded me that every patient has a story, and these stories will always have far more detail than initially identified in the history of present illness.  A patient will provide the necessary facts for a physician to diagnose and treat objectively, but to progress beyond the list of symptoms and treat the whole person takes more careful questioning, and more importantly, listening.

That Saturday night, I sat next to her bed while we talked about medical school, and how providers work with patients so closely for a period and then seemingly disappear. I wanted her to know that my transition was not for lack of caring, rather, part of the hospital system. We talked a bit more, shared a few laughs, and finally she told me I needed to get out of there and enjoy my Saturday night. As I walked out she said, “You know, you are going to make a great doctor—you really care about your patients.” I looked back, thanked her, and wished her the best. In the coming days, those simple words got me thinking.

She did not say, “You know, you are going to make a great doctor—you titrated my morphine just right” or “You picked the perfect antibiotic to kick this infection.” The decisions made with respect to her illness did not matter so much to her. What mattered was that she felt cared for. Reverence for a patient’s well being beyond objective improvement evidenced by lab work and the physical exam is one of the most important parts of the patient-doctor interaction. I strive to exemplify this with each patient I encounter. This attitude is what made this young woman my patient. With at least three sub-specialist teams involved, she continually asked me, the medical student, what I thought about the recommendations posed by various consultants. I realized this was not a reflection of how I had impressed her with my medical knowledge, but rather the trust I had earned by taking the time to recognize that this woman was more than a list of ailments qualifying her for an extensive stay on the twelfth floor.
To this particular patient, I owe a great deal. Not only did she allow a medical student to poke and prod her before sunrise each morning, she served as an important reminder of a truth so often overlooked. No book will teach us how to connect with a patient. Empathy is found neither in the hours of exam prep, nor in the pages of an impressive CV. It is found in the day-to-day interactions we so frequently take for granted. As physicians, we will be remembered not by the discharge medications we prescribe, but by how patients felt while under our care. Real people are entrusting their lives in our hands, and this great responsibility must involve more heart than simply sitting behind a computer inputting orders.  Too often, we dissociate our patient census from humanity. Passing patients from service to service and hastily sharing important details with the receiving provider as we rush on to the next task not only makes us prone to medical error, but prevents us from developing the unique bond between doctor and patient that drew so many of us to this field in the first place. To combat this, we must employ self-reflection. Though sometimes uncomfortable, it is the most powerful tool with which we can improve ourselves, and by extension, our patient care.  I am grateful for the lessons learned so early in my career, and as I progress, I hope to never forget that my patient is the person sitting before me.