You are using an outdated browser. Please upgrade your browser to improve your experience.
Become a Fellow
ACP offers a number of resources to help members make sense of the MOC requirements and earn points.
Understanding MOC Requirements
Earn MOC points
The most comprehensive meeting in Internal Medicine.
April 11-13, 2019
Internal Medicine Meeting 2019
Prepare for the Certification and Maintenance of Certification (MOC)
Exam with an ACP review course.
Board Certification Review Courses
MOC Exam Prep Courses
Treating a patient? Researching a topic? Get answers now.
Visit AnnalsLearn More
Visit MKSAP 18Learn More
Visit DynaMed Plus
Ensure payment and avoid policy violations. Plus, new resources to help you navigate the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Access helpful forms developed by a variety of sources for patient charts, logs, information sheets, office signs, and use by practice administration.
ACP advocates on behalf on internists and their patients on a number of timely issues. Learn about where ACP stands on the following areas:
© Copyright 2018 American College of Physicians. All Rights Reserved. 190 North Independence Mall West, Philadelphia, PA 19106-1572
Toll Free: (800) 523.1546 · Local: (215) 351.2400
I knew that at some point a patient would get to me. It happened sooner than I thought and came as a surprise when it did. She was an elderly patient who had been hospitalized for months due to a series of complications and infections. She couldn't speak well enough to be understood because she had a trach, and she was weak and frail. She was deemed mentally incompetent and was not listed as DNR, but when she whispered to me to just let her die, her eyes were clear. I am convinced that, at least at that moment, she knew exactly what she was asking.
I teared up when we tried to take blood from her, and the room began to look like a scene from One Flew Over the Cuckoo's Nest. Four students had to hold down this tiny, fragile woman. I was at the foot of the bed, holding her legs as gently as I could because I felt like we were breaking her. She was thrashing and fighting for what felt like forever. One vein was blown in the attempt and we had to start over. All the while, she was staring at me and begging me, or maybe God, to let her die.
At some point, another student walked in and I told him to take over for me. I took the opportunity to step behind the curtain and regain my composure. Of course, I didn't go unnoticed as a few of my fellow students walked in, so I attributed my misty eyes to this experience bringing up memories of my father's death. That was enough for most everyone to let it go. I wasn't ashamed, and I know this same patient had gotten to many other people, students, nurses, and residents alike. She was a tragic case, lost in a system where legally everything had to be done to keep her alive, whether or not that was actually her wish.
Still, something about using my father as an excuse for tearing up didn't sit right. It had been the first thing I thought of, but it didn't ring true, and yet I had nothing else to explain my reaction. "I'm human" should've been enough. But there had been something else. I let it go and went back to work. It had been a 2- or 3-minute interruption in my day, if that.
Sometimes it can be hard to know where an emotion really comes from.
I took the subway home that night. I kept thinking about what happened, thanks in part to the less-than-fully-evolved fourth-year student who had taken over for me. I had run into to him on my way out of the hospital and after interrogating me about what had happened, he suggested that I might need to choose something less intense than working in a hospital, nevermind that medicine needs more empathy, not less.
His comments were ridiculous and completely missed the point. But his ignorance, and my irritation, led me to consider the day's events and my response to them. Why would this bring up emotions of my father? He died of cancer, fighting until the last day. He never wanted it to be the end. That's when I realized this had been all about my grandmother: memories from my childhood that were, if not suppressed, at least long buried.
My grandmother taught me so much. She was clever and stubborn and defiant in the face of unfairness and ignorance. She taught me that a woman could have both grace and a sharp wit. And she was a strong woman. She had to be, because she was in terrible pain for the last few decades of her life. My grandmother, whom I called "Ginia" because she never admitted to being old enough to be a grandmother (even at 80), suffered terribly from rheumatoid arthritis for decades. I remember a slow decline, days when she would hobble around with a cane, then with a walker, then for years bound to her wheelchair, until finally she lingered for many years bedridden, suffering from bed sores and ulcers as much as from the destruction of her joints. By the time she finally died, I was in high school, and I cried tears of sadness and relief when the middle-of-the-night report came in.
I might not have fully understood what was happening when I was a child, but I do remember one thing distinctively: her unrelenting late night screams begging God to let her die. They went on for years. They certainly scared me, and probably even scarred me. But Ginia taught me so much about pain, about hopelessness through the long night, and about the strength to go on with humor and poise the next day.
I try to think of her more often now, not focusing on the pain she endured, but on the many facets of her life. It helps me relate to the patients who are unable to communicate, when all I get to see is someone sick and in pain lying in a bed. I may not have the privilege of knowing any other aspect of their life, but I know for certain there is much more to their story.
St. George's University School of Medicine
Class of 2017
Back to September 2016 Issue of IMpact