“Hey, you’re a med student. Right?” “Yes, I am. Do you need me to scrub in?” “That would be wonderful, yes! Everyone is either out on vacation or is sick. It’s just me and the resident.” “OK, I’ll be back in a few minutes.” I was on my OB/GYN rotation, and once a week I follow one of the surgeons. It was 7:20 a.m., and a patient was coming in for an unplanned, stat cesarean section. This would be my very first, and I certainly was not prepared. After scrubbing in, the surgeon conducted the time out. All ducks were in line, the nurse handed her the scalpel, and then the horizontal incision. I stood there, holding the suction handle to remove all the fumes as the surgeon used the Bovie like a butter knife. If my jaw could have dropped to the ground, it would have. The sheer speed at which she was revealing each new abdominal layer and eventually the uterus was shocking. And the amount of blood I was suctioning to keep the field of vision clear was significant. “There is a lot of blood coming out, do we have transfusion on standby?” “Yes, I do Dr. Singer. Her vitals are stable.” With the uterus now exposed, everything that happened in the next 15 seconds was a blur to me. I only remember the crying baby immediately being rushed out of the OR. So, that was my first C-section. The first time I’ve ever seen a delivery. I was scheduled to be on the L&D service at the end of the rotation, but sometimes you are called on when help is needed. Hours later, I was in the clinic at a different hospital. We were seeing patients coming in for follow up appointments for post-delivery, lab and imaging results, and hysterectomies to name a few. The last patient I saw, I’ll call her Ms. Nguyen (identifying information changed), was with her eldest daughter. Ms. Nguyen was seen two weeks ago for increasing pelvic pain and had imaging done for evaluation. Someone over the phone told her that she needed to come in at her earliest convenience to discuss the results. I didn’t have EPIC access, but went to see her as I usually did. “Hello, Ms. Nguyen?” “Yes, hi there. I’m with my daughter today.” “Pleasure to meet you both. My name’s T. J., and I am one of the medical students here today helping the residents and attendings. What brings you in?” “I had an ultrasound and CT scan done two weeks ago, and I am here for the results.” “Unfortunately, I don’t have access to them, but my resident and attending will review these with you very soon. How have you been since?” “About the same, still the pain below my belly button. I sometimes don’t notice it at all, but it’s usually in the background.” “Any nausea, vomiting?” “No to those.” “Fatigue, change in weight, pain anywhere else?” “I don’t think so, no.” “OK, sounds good.” I went on to complete the history and told Ms. Nguyen I will be back in a few minutes with the team. “T. J., you need to take a look at this,” said Dr. Sears. The attending had Ms. Nguyen’s CT scan results on the computer screen. It was a solid 4.2 cm ovarian mass. Looking at the first-year resident, Dr. Sears asked if she wanted to deliver the bad news. “I’ve not done this before, is it OK if I watched you do it this time?” “Of course, this will be hard on her. Always show empathy in times like this.” The attending knocked on the door, and we slowly filed in. “Hi Ms. Nguyen, my name is Dr. Sears, and I am the attending for today. This is my resident, Dr. Maddison and you’ve met my medical student T. J. earlier.” “Do you have my imaging results Dr. Sears?” “Yes, we do. Is this your daughter?” “Yes, I often get nervous coming to see the doctor, so we always go together.” “That is wonderful; I am so glad you are here also. OK, as my resident is logging into the computer, may I ask you a few questions?” “Yes, sure.” “Thank you, Ms. Nguyen. Is this the first time you’ve had pelvic pain?” “Not the first time. I went through menopause a few years ago and had quite a bit of pain back then. But, this time, it just feels different … I am very uneasy about it.” “I see, what is different about this pain you are feeling?” “It comes and goes, but it’s always in the background. Sometimes it can be a subtle and stabbing pain.” “OK, I see. Dr. Maddison has your CT scan here on the screen.” Dr. Sears slowly scrolled through the CT scan, until you could see the mass. Ms. Nguyen immediately started to cry, and I left the room to get tissues. I came back and handed her the tissue box, and when our eyes met, I almost started to cry. I moved silently back to my spot against the wall, and no one in the room said a word for a few minutes. I then saw Dr. Sears get closer to Ms. Nguyen, and with both hands embraced hers. “Is … this cancer? …” “The imaging shows this is possibly ovarian cancer, but this is something that you and I will go through together.” From this point on, I do not remember the conversation between them. What I do remember is just how reassuring and nurturing Dr. Sears was. I have never in my lifetime seen a doctor exude such empathy that seemed to transcend the boundaries of the room. In medical school, we are taught about how to deliver bad news, but a lecture pales in comparison to real life. To this day, I cannot believe I experienced what I did on my fourth day of the rotation. I experienced the joy of a newborn coming into this world, and I experienced the utter sadness of a potential cancer diagnosis. This was one of my most formative moments in medical school, and I will always take this with me. Empathy is not something that naturally comes to everyone. When you get a sense, or know, of someone who is suffering, you must put yourself in that person’s shoes. You must listen. Talk slowly and establish that connection with the person. Show that you truly care. If you don’t know what to say at that moment, never make assumptions and become the problem solver. Think of your answer first, and circle back with the person. Supporting someone through tough times is the true meaning of being human. Ton La, Jr. is a medical student and student editor, The New Physician. Source
