Before I Die Nicole bowden Period 7. For my carer I want to be a doctor.
The Doctor I Want to Be
2
The Doctor I Want to Be H e spiked a fever of 102.3 last night. His brain MRI is unremarkable, his CSF cell counts are inconclusive, and his urine culture is negative.” I reported these perplexing findings to my attending physician on morning rounds, pondering the next step in this patient’s treatment. As a third-year medical student on my medicine rotation, I was eager to begin learning the art of differential diagnosis and medical management. How- ever, during my time on the wards, I learned not only what it takes to be great doctor but what it means to be a healer. Mr. Mitchell was an 83-year-old man with a history of mild Alzheimer’s dementia and sarcoidosis. Three days af- ter a simple right inguinal hernia repair, he suddenly be- came obtunded and unresponsive. Just after his surgery, Mr. Mitchell was found to have a large lung mass. I spent time examining him and trying to get a response from him, but he had suddenly become nonverbal, unresponsive, and unable to follow any verbal commands. I spent countless hours with Mr. Mitchell’s wife and 3 daughters, who re- mained calm and were convinced that he would soon re- cov er fro m wha tev er had caused his sudden cha nge in mental status. I came up with more things to add to my differential diagnosis on rounds every day: listeria bacterial meningitis, urinary tract infection, pneumonia, carcinoma- tous meningitis, neurosarcoidosis, hyponatremia, and new wors ening dementia with delirium. However, every test came back eithe r negat ive or inconclusi ve. I desp erate ly wanted to find the answer; I was convinced that I just hadn’t thought of the right diagnosis, but once I did, I would be able to cure him so he could go home to his family. After a week of fluid repletion, broad-spectrum an- tibiotics, and heavy doses of antivirals, he was not getting better. He continued to deteriorate over the next few days. I felt that I just needed to try harder. It was a race against the clock . Mr. Mitchell’s wife sat by his side every day, holding his hand. I saw her cry once, and she asked me if I thought he knew she was there. I told her that of course he did, and her presence and love was the best medicine. They had known each other since they were 13 and had been mar- ried for 67 years. She brought him a beautiful red knit blanket from home so he wouldn’t have to use the hospital blankets, and she hung a picture of their family on the wall from their grandson’s graduation. On his eighth day in the hospital, Mr. Mitchell took a turn for the worse. He became hypoxic and started work- ing hard to breathe. He remained nonverbal and unrespon- sive. It was clear that he was dying. I walked into his room, and the whole family was sitting in chairs around his bed: His sister-in-law, his grandson, his daughters, and his wife. They knew this was the end and wanted to be there for his last moments. I had never seen a person in the process of dying until that day. As I watched each labored breath, I realized that dying is truly a verb—Mr. Mitchell was ac- tively dying. I sat down in the room and started talking about Mr. Mitchell with his family. We did not discuss diagnosis or prognosis; rather, I asked the m to tel l me about what an incredible man he was and to share their greatest memories. They eagerly explained that when he was just 18, he went to fight a war in Germany. He was one of the few African American solders in his World War II infantry group. Mr. Mitchell’s wife went on to explain that his greatest accomplishments and his greatest joys were his family and his 3 beautiful daughters. I sat there and just listened. I expected to be disappointed in myself because I had not found the right diagnosis or a cure, but I was not. Rather, I found it meaningful to be with the family at this very fragile time. His wife and I cleaned his face with a damp towel. I bent down and kiss ed his foreh ead to say goodbye before I left. His wife started to cry. She said to me, “There are so many doctors who are running around, just going through the motions, doing their job. It’s so nice to meet someone who truly cares and understands.” Before that moment, I hadn’t realized the effect I had on the family. They didn’t care about my diffe renti al diagn osis , my comp rehen sive history and physical examination, or the countless orders I had put in for him. But, they did notice that I cared, and that was what meant so much to them. When I left the room, I cried. I wasn’t even sure why I was crying, but I was embarrassed because I thought docto rs weren’t suppos ed to cry. I quickly ran to the bath- room to dry my tears and regain my composure. I was always told not to get emotional about my pat ien ts. I thought about that advice and realized that I would be disappointed in mys elf the day I sto pp ed cry ing . Wha t would that say about me? I realized that I don’t ever want to stop crying for my patients. Mr. Mitchell taught me about the doctor I want to be, and he helped me discover a little more of myself. He showed me that medicine is not black and white. There’s not always a cure or an answer, but there is always time to be a compassionate healer. When a patient is sick, the whole family is affected. Finding the diagnosis and the right medicine is only part of a cure. True healing means helping the whole family to heal. I couldn’t restore Mr. Mitchell’s health, but I could help his family heal. Tamara Bockow, BS University of Pennsylvania Medical School Philadelphia, PA 19104-6056 Corresponding Author: Tamara Boc kow, BS, Univ ers ity of Pen nsyl vani a Medical School, Philadelphia, PA 19104-6056; e-mail, tbockow@mail .med.upenn.edu. Ann Intern Med. 2011;155:273. Annals of Internal Medicine On Being a Doctor © 2011 American College of Physicians 273
-
Upload
cesar-arce -
Category
Documents
-
view
218 -
download
0
Transcript of The Doctor I Want to Be
8/3/2019 The Doctor I Want to Be
http://slidepdf.com/reader/full/the-doctor-i-want-to-be 1/1
The Doctor I Want to Be
He spiked a fever of 102.3 last night. His brain MRI isunremarkable, his CSF cell counts are inconclusive,
and his urine culture is negative.”I reported these perplexing findings to my attending
physician on morning rounds, pondering the next step inthis patient’s treatment. As a third-year medical student onmy medicine rotation, I was eager to begin learning the artof differential diagnosis and medical management. How-ever, during my time on the wards, I learned not only whatit takes to be great doctor but what it means to be a healer.
Mr. Mitchell was an 83-year-old man with a history of mild Alzheimer’s dementia and sarcoidosis. Three days af-ter a simple right inguinal hernia repair, he suddenly be-came obtunded and unresponsive. Just after his surgery,Mr. Mitchell was found to have a large lung mass. I spenttime examining him and trying to get a response from him,
but he had suddenly become nonverbal, unresponsive, andunable to follow any verbal commands. I spent countlesshours with Mr. Mitchell’s wife and 3 daughters, who re-mained calm and were convinced that he would soon re-cover from whatever had caused his sudden change inmental status. I came up with more things to add to my differential diagnosis on rounds every day: listeria bacterialmeningitis, urinary tract infection, pneumonia, carcinoma-tous meningitis, neurosarcoidosis, hyponatremia, and new
worsening dementia with delirium. However, every testcame back either negative or inconclusive. I desperately
wanted to find the answer; I was convinced that I justhadn’t thought of the right diagnosis, but once I did, I
would be able to cure him so he could go home to hisfamily. After a week of fluid repletion, broad-spectrum an-tibiotics, and heavy doses of antivirals, he was not gettingbetter. He continued to deteriorate over the next few days.I felt that I just needed to try harder. It was a race againstthe clock.
Mr. Mitchell’s wife sat by his side every day, holdinghis hand. I saw her cry once, and she asked me if I thoughthe knew she was there. I told her that of course he did, andher presence and love was the best medicine. They hadknown each other since they were 13 and had been mar-ried for 67 years. She brought him a beautiful red knit
blanket from home so he wouldn’t have to use the hospitalblankets, and she hung a picture of their family on the wallfrom their grandson’s graduation.
On his eighth day in the hospital, Mr. Mitchell took aturn for the worse. He became hypoxic and started work-ing hard to breathe. He remained nonverbal and unrespon-sive. It was clear that he was dying. I walked into his room,and the whole family was sitting in chairs around his bed:His sister-in-law, his grandson, his daughters, and his wife.They knew this was the end and wanted to be there for hislast moments. I had never seen a person in the process of dying until that day. As I watched each labored breath, I
realized that dying is truly a verb—Mr. Mitchell was ac-tively dying. I sat down in the room and started talkingabout Mr. Mitchell with his family. We did not discussdiagnosis or prognosis; rather, I asked them to tell me
about what an incredible man he was and to share theirgreatest memories. They eagerly explained that when he
was just 18, he went to fight a war in Germany. He wasone of the few African American solders in his World WarII infantry group. Mr. Mitchell’s wife went on to explainthat his greatest accomplishments and his greatest joys werehis family and his 3 beautiful daughters. I sat there and justlistened. I expected to be disappointed in myself because Ihad not found the right diagnosis or a cure, but I was not.Rather, I found it meaningful to be with the family at thisvery fragile time.
His wife and I cleaned his face with a damp towel. I
bent down and kissed his forehead to say goodbye before Ileft. His wife started to cry. She said to me, “There are somany doctors who are running around, just going throughthe motions, doing their job. It’s so nice to meet someone
who truly cares and understands.” Before that moment, Ihadn’t realized the effect I had on the family. They didn’tcare about my differential diagnosis, my comprehensivehistory and physical examination, or the countless orders Ihad put in for him. But, they did notice that I cared, andthat was what meant so much to them.
When I left the room, I cried. I wasn’t even sure why I was crying, but I was embarrassed because I thoughtdoctors weren’t supposed to cry. I quickly ran to the bath-room to dry my tears and regain my composure. I wasalways told not to get emotional about my patients. Ithought about that advice and realized that I would bedisappointed in myself the day I stopped crying. What
would that say about me? I realized that I don’t ever wantto stop crying for my patients.
Mr. Mitchell taught me about the doctor I want to be,and he helped me discover a little more of myself. Heshowed me that medicine is not black and white. There’snot always a cure or an answer, but there is always time tobe a compassionate healer. When a patient is sick, the
whole family is affected. Finding the diagnosis and the
right medicine is only part of a cure. True healing meanshelping the whole family to heal. I couldn’t restore Mr.Mitchell’s health, but I could help his family heal.
Tamara Bockow, BS
University of Pennsylvania Medical School
Philadelphia, PA 19104-6056
Corresponding Author: Tamara Bockow, BS, University of Pennsylvania
Medical School, Philadelphia, PA 19104-6056; e-mail, tbockow@mail
.med.upenn.edu.
Ann Intern Med. 2011;155:273.
Annals of Internal Medicine On Being a Doctor
© 2011 American College of Physicians 273
