Looking forward to my upcoming global health elective in Vietnam, I anticipate times when I will feel unable to meaningfully contribute to patient care, as my time in the hospital will be mainly focused on my own clinical training. However, I hope to overcome this feeling and find a way to contribute.
One patient interaction in particular stays with me as I prepare for this elective. The patient, a middle-aged gentlemen admitted for a bout of diverticulitis, was very slow to recover post-surgery, and struggled to be weaned off respiratory support. Over two months passed before the team realized the patient suffered from a form of amyotrophic lateral sclerosis that presents first with respiratory muscle weakness. When questioned, the patient, who could barely speak, admitted to increasing fatigue and weakness in the years preceding his illness. His condition had likely been exacerbated by the stress of surgery, and he experienced a sudden drop in function which the team knew he would be unlikely to regain.
In the face of this formidable diagnosis, the team decided to reinvestigate other possible causes of the patient’s symptoms before discussing the likelihood that he would never improve. Each day, I observed how frightened the patient was by this uncertainty. On rounds, he routinely asked, “What is happening? Am I going to die?” He remarked that no one was telling him what was going on, to which he was met with answers such as “we’re looking into a few things” and “we are going to do our best.” I was uncomfortable, but felt it was not my place as a third year student to remark on the diagnosis. There was much discussion about informing the patient that he likely did have a terminal condition, however the feeling that “one more rule out” first would be better.
One Monday, a new attending took over the service and, after being met with the same questions from the patient during rounds, decided to hold off again on informing him of the diagnosis before he fully reviewed the case. Recognizing a chance to possibly be useful, I shared the patient’s frustrations with the attending and asked for permission to speak to the previous physician about meeting with the patient. I was granted this permission, and eventually told the attending that I felt the patient was being harmed and needed to speak with the doctor who had been responsible for his care. The doctor agreed. While the conversation was unpleasant, the patient at least learned the truth about his prognosis. He was eventually discharged from the hospital, still on respiratory support, and died in his home a few months later.
This experience helped reframe my role in patient care. While I could not provide physical care as efficiently or safely as the residents or attending, I could still contribute to the team, and act as a patient advocate, especially when I felt we were making a mistake. Since this event, I have grown more confident in speaking up and stepping forward. That confidence, combined with my increasing clinical skills and medical knowledge, means I can contribute a little more every day. I hope this experience will transfer to my upcoming global health elective in Vietnam, and help me find ways to make a contribution.