As I’ve been going through my stuff looking for things to throw out for my 30 days of Minimalism challenge on Instagram, I happened upon a gift my patient S gave me on my last Internal Medicine clinic day of residency.
Memories came flooding back
“Are you staying in town after residency? Can I follow you?”, S asked me with hopeful eyes, set back in his sallow face.
S had been a patient of the Internal Medicine Residency Clinic for 3 previous residents before I met him my very first month of residency. I was so fresh my white coat was still white.
“So you’re my new intern now… lucky you. I’ve got a lot of problems.. I’m surprised you can even carry the paper chart! It’s the size of you!”
I glanced down at the 10 lbs chart grasped to my chest, the one I had just spent 10 minutes trying to decipher the scribbles prior to entering the room.
Overwhelmed doesn’t even come close to describing what I was feeling.
Problem list:
- Poorly controlled COPD
- Current smoker
- High blood pressure
- High cholesterol
- Pre-diabetes
- Etc
- Etc
- HIV
There must have been some mistake, that someone thought I was qualified enough to take care of someone like S after less than 30 days on the job. I reassured myself by remembering there were 3 attendings in the back that I was going to run everything by – if I was going to break him, it wouldn’t be on my own.
“Yep… you get me. So what brings you in today?” I asked, putting my bravest face on.
So began our 4 year long patient-physician relationship.
Every 4-6 months, he would come in with a COPD exacerbation. Every time as I handed him the steroid and antibiotic instructions, I’d end with,
“So… you ready to quit smoking yet?”
“Maybe next time. But I’ll think about you when I smoke my next cigarette.”
During flu season my 3rd year of residency, I saw him on my schedule, right on time for his COPD flare. Walking into the room, I could tell he was in dire straits.
Bracing himself on the exam room table, he was in the classic tripod position, using every muscle in his neck, chest and abdomen to suck air in and force air out of his lungs.
“Hi M,” he squeaked out. “Before you get too mad at me, I haven’t had a cigarette since I’ve been sick.”
“And how long have you been sick??”
“4 days. My inhaler just won’t kick it.”
I threw on a pulse oximeter on his finger to check his oxygen levels. The vitals written down said he was at 95%. The blue around his lips said otherwise. 86%. His lungs sounded like the squeal of someone slowly letting air out of an over-inflated balloon.
“You know I can’t fix this with just oral steroids this time, right?”
“I know.”
“Let’s get you some oxygen, nebulizers and someone to wheel you to the hospital across the skybridge.”
After a flurry of activity and phone calls, I eventually found myself sitting down next to S, listening to him hack up thick viscous mucous in between his fast, shallow breaths.
“You don’t need to sit here with me, you know. It’s the end of the day. You should go home.”
“You’re probably right.”
We sat in silence, punctuated by wet coughs and hawking sounds for another 5 minutes.
“You must have missed the class in med school where they tell you how to say I told you so.”
I smirked.
“You ready to quit smoking yet?”
S choked on his laughter.
“Never mind.. you were probably running the class.”
“Can I follow you?”
I scrambled for the right words.
“I’m sorry… I’m not staying in Michigan. But, if I had been, of course I would want to keep you as a patient!”
Downtrodden eyes landed on a package I hadn’t noticed in his hands.
“Well.. your future patients are going to be very lucky to have you. I made you this.”
He revealed a painstakingly made crimson stained glass dove, hidden in the paper bag wrapping.
“This is amazing! I can’t believe you made it! But, you don’t need to give me anything.”
“I know. But the thing is… I’ve been through a lot of docs over the last 30 years since I was diagnosed with HIV. And you were the first resident who didn’t hesitate to touch me when meeting me for the first time. You were the first one who didn’t make me feel like I was dirty. You treated me with respect. And you threw my shit back at me. I want you to have this.
Just… promise me… you won’t forget me.”
As I have been going through my journey of burnout, I’ve spent so much time focusing on the bad patient interactions.
But, there have been moments that validated why I went into medicine in the first place:
To be able to turn my 4.0 GPA into something useful to society.
To be able to earn someone’s trust to take care of their lives and well-being.
To connect to people’s humanity, not just their problem list.
Now as I am looking forward to what the next step in my journey will be and the guilt that ensues with the thought of leaving my current practice, I have to remember – there will be patients who will remember our relationship fondly. There will be patients who would be willing to follow me.
There is far more gratitude and grace that I’ve somehow forgotten along the way.
So yes, S, I still remember you.
I wonder if you remember me now that you no longer have those cigarettes to remind you of me.
Great post, M.
As an anesthesiologist, I cannot relate completely to this kind of patient relationship. It sounds like you did a wonderful job caring for S, though. And the funny thing is that even though your medical care was superb, it sounds like your ability to make someone else feel respected and valued was even better.
In my job, I don’t often get the chance to continue to build rapport with patients, but I have to build enough rapport in about five minutes for someone to trust me with their life as I take them as close to death as they will likely go before they meet their maker. A lot of this is done through the same interactions you had with S, just on a faster and smaller scale. I try very hard to let patients know that I am taking care of them in the exact same way I would take care of my wife, mother, sister, or daughter (or father, brother, son).
P.S. I love your raw and honest writing style. It really brings people into your posts.
Keep up the strong work,
TPP
P.P.S. Why don’t you have a twitter account? I cannot tag you when I share your stuff.
Thanks for sharing! I opened a twitter account just to see where some of the traffic was coming from, but for some reason the confirmation email won’t deliver to my email account and I gave up.
Also, I realized that twitter would become a huge black hole for me in which space and time would be lost forever.. haha. My handle is @Millennial_Doc but there’s nothing there, not even a profile pic. I’ll probably set it up this week.
Sounds good 🙂 you can invest as much or as little time as you want on it, my friend. I am doing the same with Pinterest right now.
Keep up the good work!
Thanks for the kind comment TPP!
I think it is a rare skill to be able to establish rapport so quickly, especially in such high stakes situations. Quite honestly, it takes about 10 minutes for people to get over the fact that I look like a child for them to take me seriously 🙂 But, I guess since they keep coming back they appreciate me… OR all the other primary care office are closing up shop or getting bought out by the big hospital conglomerates and no longer take their insurance.
Regardless, feeling respected and valued is something we all want but I’m finding more and more these things are in short supply everywhere. Which is why I really appreciate your thoughtful comments. Thanks!
Some of my fondest memories from residency are caring for a few kids from birth to 3 years old.
One stands out in particular. An IM resident had a baby at the start of her residency which happened to be the start of mine. Her and her husband let me be their doctor for 3 years.
At the time I felt like a bit of a charlatan and I knew she knew how little I knew!
But she trusted me and I still remember the picture she insisted I take with her toddler holding my stethoscope 🙂 and listening to my heart
That is so sweet! I definitely remember feeling behind for the first year and a half of residency because we switched between IM and Peds every 3-4 months. I think that’s why most of my fond memories are from my last 2 years when I was able to get out of my head and actually enjoy the patient interactions. There is something to be said for being able to establish long term relationships, which is why I went into medicine in the first place and why I chose primary care. Now if all the other crap could go away…