It’s been a few weeks since I’ve posted and now Im on my Internal Medicine rotation. Overall, its been a pretty busy couple of weeks. First for me is the inpatient month, which means I spend my days in the hospital, rounding on patients and doing your typical “medicine” type stuff. So far it hasn’t been a particularly eye opening couple of weeks, but I had an experience today that really was profound and taught me a valuable lesson.
As a 3rd year student, you really don’t have all that much of a say in treatment plans. Sure, you do your best and attendings are always happy to hear what you think might be the diagnosis and what you would recommend as the treatment plan. But let’s be honest, this early in our medical training, and we are wrong most of the time. And that’s totally OK, because we are just students and it is our first time learning these things. We aren’t expected to be the ones who “cure” our patients.
But on the inside, we all want to be the one who does make them better. It’s a natural part of why we became doctors. On the wards during 3rd year internal medicine, you are constantly exposed to sick patients who need to be treated, and oftentimes you feel like its your job to fix them and make them better. It can be disappointing at times to get the diagnosis wrong, or to propose an incorrect treatment plan to your team. It can make you feel like you let your patient down and you aren’t doing your job. I felt this way a lot until an experience today showed me the invaluable role that we actually play in patient care as 3rd year students.
Our patient was a fairly ill woman with failing kidneys and a heart arrythmia. She was acutely going through even more serious kidney failure, and had been feeling all around miserable before coming to the hospital. She is an older woman, and based on her previous medical history, it was becoming apparent to her and her husband that this could be the beginning of a steeper decline in her overall health. I had become fairly close to the patient and her husband, having done her admission interview and been on the team caring for her for over a week. I was surprised this morning when the husband followed me out of the patient’s room after my morning visit. He began by saying that out of all of the doctors taking care of his wife (yes, most of your patients will call you “doctor”), he felt most comfortable asking me something. I was extremely nervous and felt an instant sense of pressure. He went on to tell me how his wife had asked him if any of the doctors were talking about her possibly dying, and how worried it had made both of them. I was immediately taken aback and initially didn’t know how to respond. My role on the team is typically just to check on how things are going, perform a basic exam, and then report back to the team. Yet here was my patient’s husband asking me about whether or not our medical team thought his wife could be dying. I was extremely humbled that he trusted me with this question, and I did the best I could to reassure him and comfort him about how his wife was doing. He made it clear to me that he didn’t expect me to give an exact answer on whether or not his wife was dying. But it was clear that he simply wanted someone to express this emotion to. He needed to talk about the fear of his wife passing away, and her own fear that her time could be near. He didn’t need an exact answer, all he needed was a person to talk to and who was willing to listen.
I dont share this story to stroke my own ego and have people tell me that I should feel proud about this patient trusting me in this way. Rather, I tell it to help others see that the most profound impact you make on your patients at this stage in your career is not in curing their illness or making a difficult diagnosis. The difference you can make in their lives and the lives of their family is to be caring towards them. To spend time with them and listen quietly while they share their fears and emotions with you. To comfort them when they are afraid, or to reassure them when they need the confidence. To never make them feel like they are bothering you and to do your best to be there when they have questions or new concerns. We are blessed as 3rd year medical students to have the time to devote so much of our days to our patients. We typically only have 3-5 patients we are following, and this means we truly can devote the time needed to establish that invaluable relationship and trust that can easily be lost when hospital censuses become longer and longer as we progress through our career. This is precious time that we will never have again in our careers. As the patient lists get longer, the time we can spend with them establishing that trust only shortens.
I’ll continue to do the best I can to diagnose patients and manage their treatments. And I’ll keep reading and studying to learn the skills that I’ll need in my career to treat people I see. But this experience has really shown me how I can fulfill the goal I came to med school with in the present moment. At this time, for me, helping people doesn’t always mean curing their illness. Sometimes it simply means being compassionate and caring, and being there to listen when your patients need someone to talk to more than anything else.