Corrosive Canvas: Medicine

Sunday, March 7, 2010

One Day in the Life of a Med. Student.

Edi poses as Harrison's Principles of Internal...

Image by ragesoss via Flickr

This happened to me yesterday. I'm in my last year of med school and am spending a month in an outpatient internal medicine clinic working with "Dr. Jones."

Dr. Jones told me that the next patient, a 75 year old lady named "Mrs. Smith," was undergoing chemotherapy for a really early grade lymphoma. Not a big deal. Nowadays it's a chronic disease... you'll die with the lymphoma, not from it. Anyway, Mrs. Smith was presenting with a cough that was unrelated to her lymphoma. I went in to see Mrs. Smith.

"So Mrs. Smith, how long have you had this cough? any other symptoms? You coughing up anything?" etc. Then I say "So I understand you just finished chemotherapy. Is that correct?"

"yes."

"and that was for...?"

(no response)

"that was for...?"

(no response)

"that was for a lymphoma. Correct?"

"wait. I have lymphoma?"

[oh shit]

"um, yes. I was under the impression that you have a low grade lymphoma. Is that correct?"

"I have lymphoma?? I have lymphoma? are you saying I have lymphoma??"

"Well, you have a blood-based neoplasia. Is that correct? A lymphoma. Or a leukemia."

"I have leukemia??! What are you saying?? Oh no!!"

"well, I must be mistaken. Don't worry, I'll talk to the doctor about this and we'll square things out. Anyway, about your cough..."

I was in a panic. How could this woman not know that she had a lymphoma? She was undergoing chemotherapy for something. She had to know what it was, right? Maybe she was in denial and never actually heard the words lymphoma. I was so nervous. I was sweating bullets. I rushed through a throat and lung exam and ran back into Dr. Jones' office.

"Dr. Jones, you're gonna kill me. I told Mrs. Smith she has a lymphoma and she said 'I have a lymphoma??'"

She responds, "oh, well, we'll figure that out."

So we go into the room together. Dr. Jones sits down next to Mrs. Smith, puts her hand on her shoulder, looks her in the eye and says, "Mrs. Smith, you know you have a lymphoma, right?"

"Yeah, I do. I was just messing around with your med student."

Monday, February 22, 2010

Great anecdote. You made me want to call my parents and tell them I love them.

WHEN I WAS EMPLOYED,

I worked as a rehabilitation therapist.
I have a lot of notes laying around about things that I saw while working in rehab, it was the most grueling 2 years of my life.
I had a toddler and an infant at home, and I'd spend my day teaching adults how to do things they used to know how to do.
For 5 months I worked in a palliative care unit. Most of the people were there because they didn't have family to take care of them, or they needed constant care. Some had dementia.All were horribly miserable.

Here's something I jotted down in my car after a shift:

He is crying.

I've asked him about his wife, what her name was, and he responds in tears.

"Doris!" He is staring into my eyes, he is moved by something I can't pinpoint.

"I'm sorry, I shouldn't have asked about your marriage. It is none of my business."

" No, no... it's just.... I haven't said her name in years."

My stomach hit the floor. This is profound shit. More profound than I expected, I don't have experience in responding to this kind of human intensity.
I'm used to, "Yeah, I didn't get any sleep last night." or "This coffee is gross" not a 91 year old man breaking down in front of me over the love of his life that he lost four years ago after spending a lifetime with her. Not this.

Dean shimmies over to his closet without his walker, opens it and locates a large box near the top. He returns to the desk I am sitting at.

He lays it before me. A photo album.

We spend the next 2 hours pouring over his life.
From birth, until his wife's death.

His roommate enters the room. "GO AWAY ANDY!!!" Dean shouts.
Andy hobbles away, no questions asked.

My shift ended 3 hours ago. My family is at home wondering where I am. I'm here, listening to this man I barely know recall his life through tears hitting the desk. This man is truly alone. He is talking a mile a minute, memories rushing back to him. I barely understand what he is talking about. Trips, people, children, cars, pets, homes... He is vomiting his past to me as quickly as his tongue can move.

" I haven't talked about this in years, this hurts."

My dinner can wait.