— MEDICAL SCHOOL —
Oregon Health and Science University School of Medicine
— GRADUATING CLASS —
Jeff was a cranky, sometimes belligerent, and sometimes whiny patient with hepatitis C/alcoholic cirrhosis and a MELD of 32. His liver was really, really sick and had been long before I met him.
Jeff hated lactulose, hated MiraLAX, and especially hated having to report his bowel movements to the nurses. He said it made him feel embarrassed, trapped, and like he was being treated like a child. Every day I pre-rounded on him, Jeff let me know how much he hated being in the hospital and how much he just wanted to go home.
Over the 3 weeks he was assigned to my internal medicine service, I fought with him over his MiraLAX, over his fluid restriction, over one more night in the hospital—you name it. I tried to be as compassionate as I could, listening to his concerns and lessening his burden whenever possible, but at times I felt more like his warden than one of his medical providers.
The first time I saw Jeff cry was a clear morning when he had taken all of his MiraLAX doses for the past 2 days and “had [his] head screwed on straight,” as he liked to say. He knew he was sick, and feared he wouldn't qualify for transplant and would just “be sent home to die.” I sat with him for a bit, mostly listening, but what was there to say? The options looked pretty bleak.
Regardless, I pressed him to forge on. Noncompliance was a huge issue for him, which I later learned after attending his transplant committee evaluation, especially regarding his MiraLAX use. From what I'd noticed from working with him over the past few weeks, however, he was only really noncompliant when he was already encephalopathic. On his clear days, he would express his displeasure but would take the MiraLAX regardless. So I doubled down on him, intermittently nagging or cajoling him to take it and pressing the nurses to demand compliance. His compliance improved somewhat, as did his mental clarity.
Still, I was shocked when he was finally listed for transplant. I was even more surprised when, a week later, I got that fateful page. Jeff had a liver! I went to congratulate him, only to find him once again in tears—happy tears this time. I congratulated him on the good news, and he smiled at me, the first smile I had seen from him in days.
“I'm really anxious,” he confessed. I reassured him as best I could. “Will you be there at my surgery?” he asked. “Will you come check on me after? I just want a familiar face when I wake up. Everyone here is great, but I've seen you every day I've been here and you're the only one I've really bonded with.”
I stifled my surprise. I couldn't believe that this man, whom I'd pestered and nagged every day for the past 3 weeks, wanted to keep me around any longer than he had to. As a student, I was the person who had contributed the least to his care. Our provider–patient relationship had been strained, to say the least, and there had been feelings of frustration (and even resentment at times) on both sides. Still, I couldn't bear to disappoint him after finally gaining his trust, and I promised him that I would be there for his surgery.
He was rolled back to the operating room at 8 p.m. that same night, and, despite his optimism in the PACU a few minutes earlier, I could tell he was scared. His jaw clenched, his eyes a little moist from unshed tears, he lay there on the bed, uncharacteristically silent. I caught his eye as he moved onto the operating table, and he flashed me a quick thumbs-up before he went under. I stayed all the way through his surgery, and was overjoyed when I went to check on him in the ICU the next day.
Jeff recovered remarkably well, and went home the very next week. I still think about him a lot. I think about how scary the hospital can be, how powerless our patients often feel. I think about the immense power and privilege we have as providers, and how sometimes even the smallest of concessions—one less dose of MiraLAX today, 200 mL more on a patient's fluid limit—can make a world of difference to a patient who feels like their whole world is spiraling out of their control.
I think about Jeff's smile, and the hug he gave me on his last day in the ICU that made it all worth it. I can't help feeling humbled and unworthy of his gratitude. After all, I was the person on his team with the least experience, the least knowledge, the least skill. It didn't make sense that he would want me in his surgery when he was already surrounded by more competent, more experienced physicians.
Several weeks after I had already left the internal medicine service, I began to understand Jeff's perspective and maybe why he had asked me to stay for his surgery. I was working in pediatrics, and my resident asked me to update the new nurse on the plan, so off to the nurses' station I went. The HUC helpfully pointed out the nurse in question and when she turned around, my eyes widened in surprise. It had been 8 going on 9 years, but I was sure I recognized her face.
I introduced myself and gave the message I was supposed to. As she turned to go, I hesitated, but before I could fully make up my mind the words started spilling out of my mouth, escaping of their own accord. “I'm not sure you remember me,” I began hesitantly, “but I was actually a patient here many years ago and you were my nurse.”
Nurse Anne turned to look at me closer, her bright blue eyes—now with a few more crinkles around the edges but with the same ageless kindness—both surprised and inquisitive. She asked me a few questions about my hospital stay and slowly I could see the recognition begin to dawn. “You're a med student here now?” she asked. “And you're doing well?” I assured her that I was, and we exchanged a few more pleasantries before we both had to head about our days.
For her, I was just another patient. One single drop in the bucket of the thousands of lives she has touched as a pediatric nurse. But for me, she was so much more than that. She was the one kind face in a sea of suffering, the one sympathetic smile on my worst day during the weeks I was in the hospital. She will never know how much she meant to me, and how her kindness in addition to her medical care helped me through one of the more difficult periods in my life.
Looking back on it, I hope that I was able to pass on a little bit of the gift nurse Anne gave to me through my care for Jeff. I may not have been the most experienced or knowledgeable person on his team, but I was one of the few who knew how much he loved raspberries or understood the depths of his love for his wife, Amy. Even if that's all I was to Jeff—one kind, familiar face in his personal sea of suffering—I am proud because I know from firsthand experience that I played an invaluable role in his care.
Catching a glimpse of my own reflection as a future provider, through the eyes of my younger self as a pediatric patient, reminds me of why I went into medicine in the first place. As physicians, we have the unique privilege of caring for our patients medically, while also supporting them as people and even friends.
With every life we touch, we have the potential to make someone's suffering a little better, to make their burden a little lighter. And, although one small act of kindness may seem insignificant to us throughout the course of a hectic day, it may mean more to our patients and their families than we will ever know.
Back to the November 2022, Issue 2 of ACP IMpact