Starting medical school, I knew I would see people on both the best and worst days of their lives. I would witness births and deaths and come out on the other side as a skilled professional. However, I never expected death to be so blunt. On my first day in our student clinic, we saw a patient who had stage 3 chronic kidney disease. He was Spanish speaking, and I recall stuttering through my first ever patient interview, grateful that he seemed unbothered by my lack of experience. We learned a little bit about his story — he had a wife and two kids he hadn’t seen in almost eight years back at home. His children were 12 and 9, just babies when he left them. He seemed thankful for our help and kept smiling at us while we listened to the phone interpreter. We called in our attending who spoke with the patient, and then led us out of the room. With the door shut and out of earshot, he stated, “He has six months.” I felt like I’d been slapped. My knowledge of disease processes didn’t go very far, and I couldn’t believe what I was hearing. A casual statement and that was it. We were left to make follow-up appointments and finish up the day. As I walked home that evening, I wondered if I was just overreacting – it was just a statement, doctors make statements all the time, why was I so bothered? Our patient did fine for a few months, and then he did die. Not due to his illness, but a freak accident, leaving me even more shaken at the fact that death seemed to be constantly lurking around the corner. Today, almost exactly two years later, my views of medicine have shifted. I understand more about the ins and outs of the healthcare system, the costs of healthcare, and the sudden worsening of a disease we are often witness to. I see patients who don’t have much time left, whose prognoses leave me calling my loved ones because of the dreaded medical student syndrome. And then there are moments when I’m speaking to my family and friends, and I catch myself being a little too cavalier about a hospital story, I stop and rewind. I remind myself that this is what someone is going through – and they deserve more than a “they’re going to die soon.” As I continue through my year, I am thankful that I was bothered by that statement long ago. During the past two years, I have heard that same statement many times, and each time I am bothered. Each time I work with a doctor and they say: “They’re going to die soon,” I find myself obsessively checking the patient chart. Looking for a clue, looking for anything that might tell me otherwise. But that worry, that twinge of sadness, that occasional tear I feel comfortable shedding only at home, reminds me that I am still me. I have nothing against these doctors; I know that they excel in what they do and take care of their patients. But, I constantly fear that if I show them how I feel, I will be seen as weak. We have been trained to form a separation between ourselves and the patient, but there are days where that does not seem possible to me. I can still remember the smile of my first patient when he talked about his children. I had only asked about them because I was struggling to remember what to ask in my review of systems, but it allowed me to connect with him. I was able to see him as more than my patient, but as a man who was scared and loved his children, and I was almost brought to tears. Too often in medicine, we feel embarrassed or silly for our emotional response. On the floors, I know I spend too much time with patients. I know that asking them about their favorite recipes and pets isn’t part of the EMR. But I do it anyway. When a patient I had for days asked me why I was so excited for her to be able to leave, I replied with, “You can make your own chicken wings again,” and she looked surprised, responding with “I never thought you people listened to that stuff.” Statements like “they’re going to die soon” are a way to avoid getting too attached, a mechanism used to get through a hard day. As I progress, I realize I need the attachments. They guide me, they remind me what matters, and they allow me to grow. Natasha Mathur is a medical student. Source
