Life on the Wards

“The patient is a 47 year old with metastatic esophageal squamous cell carcinoma locally invading the stomach, pancreas, and left adrenal gland who came to the hospital with dysphagia to liquids and solids then found to also have multiple liver abscesses and potential metastases to the liver. Would either of you like to cover this one?”

I should back up. My M3 [third year medical student] partner and I started on the hospital wards at the end of August 2011. At that time, the team already had several patients for which to care. One of the M3’s switching off of the team pulled me aside and told me I needed to meet one of the patients, this “adorable, sweet man.” When my new resident presented his case, I jumped at the opportunity. I had no idea what was ahead of me.

On the first day, I was overwhelmed by the unfamiliar system, by the hectic wards, and by the length of the patient’s medication and problem lists. [The patient] had only been in the hospital for a quick 5 days prior to meeting me, but his chart had grown fat quickly. Getting to know him on paper seemed onerous and inappropriate. I went in to see my first patient, and we chatted.

Over the course of my time in the hospital, I got to know this patient well. I met his “on-and-off girlfriend,” some of his estranged family, and some of his close friends. His story is a sad one, to be frank. He came to the United States at the age of 12 years, following his mother who had just met an American. He left his family to make it on his own — we didn’t really discuss what had happened — but he got by for nearly 30 years as a bartender. He loved his work; it became his life. He had regrets though. He worked in a closed bar in which smoking was encouraged. Further, he was so loved that he was treated frequently to drinks by his customers. Consuming five beverages nightly was commonplace for this patient. He wondered if his lifestyle led to his present illness.

He didn’t truly want to face his diagnosis. I didn’t blame him. His denial was only surpassed by his anxiety and his shyness. Indeed, after only a day of talking, I was the only person the patient would confide in since I was a man, unlike everyone else taking care of him. He didn’t want to be rude inasmuch lose his “machismo,” as he put it. After some intimate conversations and delicate aspects of the physical exam, our trust grew. And, I felt like I was actually helping: I could now relay appropriate information for care to my team without undue embarrassment or fear to the patient. I felt like I had some utility; it was great!

Later, the patient became confused. He had a lot to deal with: plenty of drugs, lots of pain, and a relentless infection. Then, I returned a page … I was asked to swing by the patient’s room. I was surprised to see him in distress, in pain, and in the throws of acute delirium. Then, he saw me. He smiled and said, “Oh, it’s Vinny, the greatest, nicest guy I’ve ever gotten to know. Have you [nurses] met him?”

I turned bright red. I just tried to help the incredible nursing staff and the patient make it through that complicated morning. Eventually, the patient came around and felt better — the hospital nurses were really something else! We had some somber conversations. I also had the privilege bestowed upon me by my resident to start conversing with the patient’s significant other.

After the subsequent afternoon of lectures, I was en route to meet my team when the patient’s nurse waved me down. The two nurses who helped the patient that morning updated me on the day’s events and asked for my opinion on some of the plan of care. Then, they mentioned that his family and friends brought food for the people taking care of him, specifically asked to save me a plate. I was touched by the whole picture. I followed up on my discussions with the nurses, heading back to talk to them after touching base with my resident.

After his nurse insisted I take the food home, I asked her to page me along with the hospital cover team if I could help that weekend (even though it was my “Golden Weekend” away from the hospital). Her reply touched me: “Well, Vinny, you know, the other night, when he was first really confused at, like, 3 a.m., he asked for you. He was really worried and concerned and wanted us to get you down here. We didn’t know how to reach you, but he might want to see you if something goes on again. He really likes and trusts you — I’ll make sure they page you. Thank you for all the help today!”

The patient — my patient — touched me in ways I didn’t think possible as an M3. He showed me the utility of medical students. We have such a vital role if we can take the time to personally invest in our patients. Then, yes, they will be our patients. And, while it may be a misnomer, our patients can be comforted by calling us their doctors. The greatest lesson I have taken away is that we’ll never truly know how anyone we encounter can change our lives. My patient may think I’ve done something for him; however, the converse is most definitely the reality. [My patient has] inspired me to be better while showing me what a medical student can bring to the team so long as we put in as much work as we can. I know I can do more, and will. [I will do it] for him, and for all of the people who, in the near future, will grant me the privilege of allowing me into their lives.

DiMaggio says the patient was eventually discharged home with only palliative measures. He never heard again from the minimal family the patient had.

by Vinny DiMaggio, M’13, School of Medicine
(Published July 11, 2012)