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Patient care — worlds apart
Sometimes there is more to being a doctor than medicine.
It was a Saturday morning in late June when I left Boston, just hours after seeing patients on the renal consult service. I started orientation in North Carolina two days later. In the past three months as an oncology fellow my life had been far removed from the world of a medical resident. I would like to share three anecdotes that I think describe some of the similarities and differences between these two worlds.
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Four years ago, when I began seeing patients in an internal medicine clinic, I was not sure that I knew what I was doing. On one of my first afternoons, an elderly black woman smiled back at me reassuringly from the exam table. She told me that I was her sixth or seventh doctor. At three years per residency, for 18 to 21 years, she was probably about right. During the time I spent with her, I felt that she was doing more in teaching me how to be a doctor than I could do for her.
I reviewed her list of 15 to 20 medications that first afternoon, and read several subspecialty notes in the electronic chart. Mostly, I tried to “first, do no harm” by following the lead of the residents before me and the specialists alongside me. One day, I found her in a hospital bed, laboring to breathe during an inpatient admission for a flare-up of chronic obstructive pulmonary disorder. I sat beside her and she held my hand. In seconds, it seemed, her breathing slowed and deepened. Although I might have felt powerless to provide meaningful medical care to her, it was clear that day that as her primary doctor, I provided strength and comfort.
A corporate executive with a new diagnosis of multiple myeloma waited for me during one of my first mornings in the malignant hematology clinic. He had been referred to one of our center’s myeloma experts, but somehow ended up in my clinic. I addressed his fear and anxiety during his first visit. I told him what modest information I could, and was relieved when one of our attending physicians came to my rescue. As the weeks moved on, I learned everything I could about myeloma. The patient always returned to the clinic to see me, many times under the supervision of different attending physicians. I visited him in the infusion center, talked with him late at night after being paged for emergent issues, and corresponded frequently by e-mail. It became clear that I was his oncologist, and that I bore responsibility for his care. When I shared laboratory data with him after several cycles of chemotherapy, his wife smiled and squeezed my shoulder. “You’re doing such a good job!” she enthused. Although I could not take credit for the work of his chemotherapy, I knew then that my new position of responsibility was as gratifying as it was frightening.
Late on a Saturday night, in the middle of an exhausting division call, I left the hospital to pick up my wife at the airport. My pager beeped for the 30th time that day. Cursing, I snatched the pager from my belt and depressed the button to view the callback number. I mustered a weary professionalism in response to the voice on the other end of the line. The caller was a mother who wanted to know if she should give her son more dexamethasone. She was a nurse by training, and he was a 28-year-old armed services veteran dying of a glioblastoma multiforme. Although he had decided some time ago to forego active treatment, he was experiencing more facial droop as he lapsed in and out of lucidity. As I heard her story, the sadness and pain of personal tragedy engulfed me. I realized as I continued to talk with her that the call wasn’t really about dexamethasone — it was about a scared and grieving mother wanting comfort from a doctor, any doctor, as her son lay dying. I thought back to early in my residency, when I similarly felt that there was little medically that I could offer my patient. What I could give, however, in the currency of human compassion and understanding, remained as important now as it was then.
Bill Wood, MD, is a second year hematology/oncology fellow at the University of North Carolina Chapel Hill and is a member of the HemOnc Today Editorial Board.