I have had a number of patients who were very ill in the hospital, with a number of co-morbidities that were so tightly knit that one thing that went wrong dramatically affected multiple organ systems. Most of the patients I followed had poor prognoses that eventually led us to consult Palliative Care. I will never forget a certain patient. He was a big fellow with a big heart and a sharp sense of humor who had drawn a number of unfortunate cards in life. He faced complications from surgery that affected his once stable condition. It was very difficult to manage his medical problems and his course was up and down daily, but I remember there was a time when I thought he was getting better. Then his health changed dramatically and in a day we could no longer treat his condition as he was refusing all treatment. Delirious, he repeated “I just want to go home. Take me to the woods.”
Maybe I was naïve, but it didn’t occur to me that he was not going to get better. I religiously followed his health daily and thought he was stable if not getting better and now there I was in the workroom, shocked and upset. I realized I was so engrossed in the medicine and research and developing a plan for the patient that I forgot this was real life for him. My role as a student was lifted from me at that moment and I felt human and also powerless. We had all the right intentions and did whatever we could, yet it was not enough.
The family care conference was especially difficult for me. I spoke to his family quite frequently and the rapid decline was very upsetting to them. I felt as shocked as they did. I was just learning that his specific disease tends to be one that can plateau for a while and then suddenly take a turn for the worst. They decided to stop all treatment and take him to hospice as he had only a few days to live. I could not stop myself from showing tears… in front of my whole team and the family and the palliative care team! In my head I was saying, “Get it together!” Still, I couldn’t stop. I felt so grateful for this patient and for being part of his life if only for a few weeks. I learned so much from him. I don’t think he realized he left me with that gift, but he did and that it was a precious one.
In medicine, we are blessed to be part of the lives of strangers. They allow us and trust us to see them in their most vulnerable states. They impart lessons to us on a daily basis, solidifying our knowledge in the best way— through experience. I hope I never take that for granted.