Shades

1.

I once had a patient who told me about his lost love.

He was a writer. Middle-aged. And his voice was so soothing that it immediately brought a mental halt to the rush that clinic usually consisted of.

There are a few patients that I wish I could have had more time with – more time to hear their stories, their backgrounds…what makes them tick. These patients are automatically able to keep me present, to slow my mind that’s always waiting and watching and planning for the next thing.

He was one of them.

And it was peaceful.

He told me about his wife that had died from a rapid form of multiple sclerosis. It was a story of death I had unfortunately heard many times before in the hospital, but my breath caught when he not only told me the amount of years but also the months, weeks, and days it had been since she died.

He recounted how he had dreamed the other night about her. The emotions he expressed were so raw, and his desire to be with her so heartbreakingly, poignantly felt, that tears threatened to spill over and I felt chills go through me. There was a selfish part of me that in the moment (and even months later) ached for a true, mutual love like he had.

Her presence should have been (was) there. His voice remained the same calm cadence as he spoke, though not without cracks of emotion breaking through. Had those cracks been present every day of the years, months, weeks, and days since her death?

I walked out of the room looking at the world a shade differently due to him, my world having slowly been filled with more and more shades as third year had progressed and I learned more and more lessons from incredible patients.

Is it ironic that he was at clinic for an issue with his heart?

2.

I once had a patient who was starved by her step-father.

She was five. Severely underweight. Her step-father abused her, hit her, and withheld food from her to the point where she had been eating paint chips to try to get nourishment.

Her mother was just as malnourished as my patient was, but far more haunted and far more defeated.

I was in the pediatric floor hallway with my team one day as the little girl rode by on a mini tricycle, a wide smile on her face as she looked forward right past us and kept going without a single glance.  

I never saw her mother smile like that, and I sadly wondered if the little girl was one day going to have the same smile – one that never surpassed grim and forced.

On my last day on the service, I went in to say goodbye. The little girl ran up to me and excitedly showed me her painting.  I’m torn on whether it was painted in blue or purple, but I remember one of those colors was her favorite.

It’s been over a year and I still hope that excitement and smile is still there.

3.

I once had a patient that I accidentally caused unnecessary pain.

It was a simple staple removal from a surgery on his neck. It had been awhile since I had removed staples and I accidentally removed the first one incorrectly. He gasped in pain as the staple dug in deeper, and the shame and fear I felt at just that minor error raced through me.

I apologized (but does that even matter?).

It took me a couple of minutes to slowly correct my mistake. My voice was clear and reassuring as I distracted him from the added pain by asking about his life story and his family, though I’m glad his head was turned away from me so he couldn’t see my hand shake as I slowly (and painlessly) removed the rest of the staples the correct way.

At the end – he thanked me and told me to have a nice day. I probably wished him the same.

I walked out of the room feeling inadequate. If I had screwed up something so stupidly simple, how was I supposed to handle anything else? Imposter syndrome at its finest.

Since then I’ve removed plenty more staples, never making the same mistake again. I’ve also done more difficult procedural techniques since then with no problems.

However, I still remember that staple and the pain I caused.

I also remember the humbling power and responsibility that I had over causing or not causing that pain.

“Do no harm” is the ideal command of perfection that should be applied to every person and every situation.

But what do I do about the fact that I am so imperfectly human?

4.

I once had a patient that gave birth to her first child.

She and her husband were a kind, soft-spoken Indian couple. They didn’t speak much during her laboring process but their joy didn’t need to be expressed in words – I could see it plainly written across their faces. It was an unashamed nervous excitement, and the energy of it permeated the entire room.

I sat with her at the foot of her bed for at least 2-3 hours, working through each pained push alongside of the nurse, listening to her baby’s strong heart beat on the monitor as we encouraged her to take deep breaths.

Her husband never let go of her hand.

As the end (or was it the beginning?) neared, the attending walked in and we put on gowns and gloves. The foot of the bed was dismantled to get ready for the final pushes. The excitement grew. The simple, soft-spoken encouragement turned into loud cheers from everyone and I was reminded of when I used to play sports in high school.

Everybody was distracted in the room by the closeness of the baby’s arrival but I felt hesitation as I stood where the resident or attending would normally stand – in the spot of the person that would deliver the baby. I took a moment in the loudness of the room to look back at the attending that was standing right behind me.

I leaned toward him and murmured softly, “You know I’m a 3^rd year medical student and not a resident, right?”

He smiled and nodded. I haven’t forgotten that twinkle in his eye as he gestured forward and my uncertainty disappeared.

A few minutes later the baby was delivered – a girl. The nurses took the healthy, crying baby from the attending’s hands and mine and placed her on her mother’s chest.

I’ve done a lot of cool things in medical school, especially as I delve further and further into the surgical world, but helping to deliver their little girl still has to be one of the most amazing things I had the privilege of doing.

I also still feel honored to have been able to witness their first moment as a family - the look of pure emotion on the face of her parents one that I’m certain can’t be rivaled in our present day society.

5.

I once had a patient that refused to give up.

Would it then be a contradiction to say she that was admitted to the psychiatric unit for depression and suicidal ideation?

She was 16 and had already been through more mental, physical, and sexual abuse than any human being, let alone someone her age, should ever have to go through.

I spoke with her for nearly two hours. A nurse practitioner was in the room with us, tuning in and out to the conversation and occasionally chiming in, but overwhelmingly leaving the conversation up to me.

The girl’s kind demeanor was just one of many things that struck me about her. There was no coldness, no bitterness, and no anger – though any of those emotions would have been justified. Instead, she had a simple reserved softness along with a dry sense of humor and a resigned sadness in her eyes.

A part of me lamented at the fact that the conflicting parts of her personality were likely due to the way life had treated her, while another part of me was hopeful at the obvious glimpse of resilience that she portrayed.

The prepared, organized (and impersonal) template of questions quickly gave way to a more natural life conversation that interestingly still gave me all of the information I needed for official documentation.

We talked about things that made her cry as she shared some of her life story for the first time with me. I tried to contain my tears the best I could but she must have noticed them at some point (and that’s okay).

We also talked about things that made us laugh. We were 10 years apart in age but still close enough within a generation that we could share pop culture references, giving each other a knowing, humorous glance when the older nurse practitioner tried to join in and comically failed. 

We went from one moment talking about the ridiculousness of 50 Shades of Grey to another talking about how she slept for a week on a mattress by a dumpster behind a closed down taco restaurant. The casual juxtaposition of topics made my head spin and reorienting myself during our conversation was challenging.

I left that day shaken, angry, and heartbroken that she, by no choice of her own, was born into a life situation that persisted in trying to snuff out the light she so clearly exuded.

As each day progressed, and as therapy, medication, more tears, and healthy discussions with nonabusive family members occurred, I saw her get stronger. The potential promise in her future with the life goals that she had was hopeful.

On my last day – a Friday – I took her aside and wished her the best and told her that I had enjoyed getting to know her as a person. She thanked me for listening and told me she was going to miss me for the rest of her admission. We gave each other a hug.

I don’t know what happened to her but I think of her often. I sometimes check her patient record to see if anything new happened and I can never discern if I feel relieved or frightened that there have been no new records since she was discharged. She was the backbone of a speech I gave a few months ago – an example that will always remain fresh in my mind on the strength of patients through adversity and the power that can exist between a patient and those that are taking care of them.

When she does cross my mind, I always hope that she’s doing well and that life has been more kind to her, but just as importantly, I also hope that she’s continued to fight with the resilient spirit I saw those few days when she was my patient.