Know Your Patient

One of the expectations of students during internal medicine rotation is to “know your patient.” An attending once told me: “You should know your patient’s vital signs overnight, their new imaging results, who lives at home with them, what meds they are taking, even the name of their dog.” His statement produced a few chuckles, but we all knew he meant it.

So I got to know my patients very well. I knew how many units of insulin they needed in 24 hours, how much Norco they asked for overnight, at what time they spiked their fever of 101.5, what color their Foley catheter output was, what percent of their meals they ate, how many surgeries they have had, and where exactly their pain was. I knew the names of their family members because I was asked to call them to give updates. And yes, I knew the names of their pets. At times, it felt like I knew my patients better than I knew myself.

When I think of how many hearts I’ve heard…

…which is why I was devastated when one of my patients passed away. He was transferred to the MICU from my team’s service because of a respiratory complication. His family stopped by to see him that morning, and we shared the news. I was as frightened as they were, only I was better at hiding it. I told them there was a chance he could get better and come back to our service. But he didn’t.

I found out about his death a few days after it happened. It felt odd to be connected to someone yet still be so far removed from them. It felt strange to think that his vitals were no longer being charted, his ins and outs recorded. I wondered how his family was feeling and if they were able to say goodbye. I wondered if in the MICU he remembered me, that little medical student who came to check in on him every morning. I felt a sense of loss but didn’t quite know how to deal with it.

Death is an inevitable part of a physician’s experience, and I am realizing that more as I spend more time in the hospital. Not every patient who gets admitted will get discharged. It’s a reality that is often not talked about because it instinctively ignites sadness and fear. As medical professionals, we like to think that we are saving lives. Death sometimes feels like failure to us because we are working so actively to prevent it. But death will still happen no matter what we do to prolong it because it happens to everyone. So how do we deal with it?

When a patient did not show up for her clinic visit because she had passed away, one physician requested, “Let’s have a moment of silence to pray for her and her family.” And with sincerity, he and I closed our eyes and prayed. Another time, my residents discussed, “What could we have done differently? How can we improve in our care?” Some reach out to the patient’s family. I witnessed an attending physician tearfully and silently hold the hand of a dying patient’s husband. Some manage by being focused on their own health. Right after work, they do intense cardio exercise and eat a healthy dinner. Others are the opposite – going out for sweets brightens their days. One physician said that she has designated “cry days.” She’ll set aside a day every couple weeks for catharsis, when she will evoke tears and cry for everything at once. Others simply continuing on with their work, addressing the medical and logistical issues at hand, as if it were just another day.

Death sometimes feels like failure to us because we are working so actively to prevent it. But death will still happen no matter what we do to prolong it because it happens to everyone. So how do we deal with it?

The reality is – being a physician is emotionally challenging, especially for a touchy-feely person like me. Whenever I have the chance to stop and reflect about my work (like now), I am surprised at how much I have been able get through. Perhaps that is why I like to keep myself busy – so that I don’t have time to experience the full extent of my thoughts and emotions.

In the end though, no matter the difficult journey or outcome, I am truly grateful for every patient I meet. They all have valuable wisdom to share, and I have become a much better person because of them. By knowing my patients very well, I can provide the best care possible for them. And with every loss, I am learning how to deliver better care. I am also learning how to deal with my instinctual emotions through prayer, positive thinking, reflection, and meaningful conversations. I am learning how to give comfort to family members and balance reality and hope. Importantly, I am learning how to appreciate life all the more.