Strength

I think a lot of times as medical students we feel inadequate. We feel overwhelmed. We feel not good enough. I think this is the case a lot of the time. Going to see your first patient in free clinic, or ACA, or even deep into 3rd and 4th year honestly.
So like everyone else in medical school, I feel the same feelings of guilt and embarrassment, with just a touch of pride that we all do when a patient mistakes me for a real doctor. And I mean the guilt and embarrassment, of course, comes from not knowing everything, or really anything at all sometimes. And that pride comes from knowing that someday we will know.
That we’ll walk into a room with full confidence we’re going to take care of our patients.
We will do everything to make them better.
That we’ll one day deserve that title.

But be humanistic? I thought I can do that. It almost sounds funny, because you come into 3rd year thinking of course we’re going be humanistic. We just had 2 years of POM. We can all do that. *wink*
But it doesn’t happen all the time. And I don’t mean to judge. It’s hard. It’s busy. Not every one is mentally there all the time. We’re worried about impressing this person and that person, and of course we are all guilty of it.
And I think what gets lost in all this, is that it makes a difference to just be there, not just for the patient, but for you. I was lucky enough to have a patient show that to me early on.

I was on my first day of my first rotation. And that sounds more dramatic than I’d like, but there it is. I had gyn-onc, which meant I was a bit sleepytime. For those of you that don’t know, it starts usually around 4am and ends around 6-7pm. I got assigned my patient on that day. Ms. B, let’s call her.
She had late stage cervical cancer and prognosis wasn’t great. She was in for a SBO – a small bowel obstruction. She was real young. I’m talking 30s. She had 2 amazing, awesome, and hilarious kids. Her mom took care of them. Grandma B aka Queen B. She seriously held it down.
So first day, I get in there and I introduce myself.

Ms. B says, “So, you’re a doctor?”
And I said, “No, no! I’m just a medical student.”
She replied, “Well you’re really young, that’s all.”
And I said, “Well, maybe I’ll grow on you.”

Which is not funny, but she laughed. Which is the best sound when you’re nervous as all hell, you know. And we talked a little bit, and I said I would be helping take care of her from now on.

So next day, I’m pre-rounding. I got my questions I wanna ask, I know what physical exam I gotta do.
And as I came in, she’s in pain. You can tell.
And she said “Boy, I know you are not in here to press on my stomach. One of you already came and did all that.”
I went over and I just asked her how her night went, eventually maneuvered into asking if she passed gas or *fingers crossed* had a bowel movement, meaning things got better. No luck.
I said, “So I have to do this physical exam.”
Daggers just started shooting out of her eyes.
I said, “Honestly, I just wanna help. If you don’t want me mashing on your stomach, I understand that. This is really for my learning more than anything, and that always comes second to how you feel.” So I said that, and I don’t if it was the right thing or not.
She agreed. And I lifted up her gown to expose her abdomen.
She said, “Not a pretty sight, huh?”
And suddenly I realized, it doesn’t matter if you’re 14, 40, or 90. It sucks the same when someone just looks at you, and you’re vulnerable, and you just don’t feel your best.
She had gotten a few surgeries already and she had areas of loose skin and a few scars along with an ostomy bag, which is a bag connected to your colon.
And so I looked at her and I said: “Are you kidding me? Ms. B, you are in the hospital, you’re feeling like trash probably, and you’re still killing it out here. I got dudes outside in line asking for your number, it’s shenanigans.”
She laughed a bit and said “Boy, you stupid” and sort of hit me with her hand playfully.
That was when I first noticed her tattoo. I didn’t get a good look, but I saw it. Her only one. Usually, not all the time, but when people get just 1 tattoo, that usually means something. I mean of course you can have a lot and have them all mean a lot. But this is just my experience, and it could be woefully ignorant.

So a few days later, she’s in bad pain again. Things aren’t going too well; we’re considering surgery now for the SBO.
I go in and she’s really upset. She’s in pain, but also something else. I don’t have to talk about it, she knows we’re all really busy she says. And told her that I wanted to hear, and I wanted to be here.
She told how she missed her kids and how she hated this. She hated feeling this way and being in bed. She hated the exams because she felt dirty all the time, and she didn’t want people to feel dirty after they touched her. She hardly even let her kids hug her when she was in here. We talked a little more, and I asked her what her kids might be doing. And she said that Grandma B was real soft and probably had them eating unhealthy stuff like burgers and fries. I said sometimes you just need that though. And we went on to talk about our favorite burger joints, and where she would go when she got out of here.
Then I asked if I could see her tattoo. She showed me.

It was an infinity. For those of you that don’t know, that holds a particular significance to a decent amount of us. And it hurt to see it.
There’s a great quote in a great book: “Few doctors will admit this, certainly not young ones, but subconsciously, in entering the profession, we must believe that ministering to others will heal our own woundedness. And it can. But it can also deepen the wound.”

It was an infinity with the word “Strength” in it.
I asked her why “strength?”
To which she replied, “Well it’s so I have the strength to deal with all this bullshit.” A woman of my own heart.
She said she, her mother, and sister got them at the same time. Her mother’s said “Faith,” and her sister’s said “Love.”

“When I look down at it, I get the strength to keep going and I feel loved even when I feel like everything else is crumbling around me.”

And then she told me a bunch of stories. Hearing those stories was the best feeling, during a time I felt incredibly low. But she was there for me. I told her a few stories back, and I got a few pity laughs and god I hope she felt even a little better.
Few days later, things still weren’t great and she wasn’t doing well in general and we decided we had to go to surgery to take out that section of bowel and reattach the pieces again. The intern was really overwhelmed and she let me talk to her, letting me be more autonomous than I deserved.

I talked to her in the next early morning and said we would likely go to surgery. She got really scared and asked if she was going to die soon. I told her I wished I was smart enough to answer that question, and that she should ask on rounds. And she said she understood what I was saying, and asked if I could stand next to her when the whole team came in.

So on rounds, I mentioned that she was going to ask this, and the team felt like that wasn’t an appropriate question, to say nothing of the fact that it was impossible to answer. We go in, and I stood next to her, and we talked about surgery in the near future and the senior resident said she couldn’t answer her question. It just didn’t feel good, you know. It wasn’t anyone’s fault. But sometimes you just feel interactions don’t go well. And things move so fast sometimes that you don’t really do anything about it. We were wrapping up when I got this idea. The team was leaving and she was upset, on the verge of tears. I lagged behind a little, and I pulled the marker off her little white board in the room and drew an infinity. I looked up at her. She graciously smiled at me, and said I better be in the surgery. I said I would be of no use at all.

“Boy, just be there.”

The surgery went well. Her bowel was in all the wrong places, and it looked angry, and there were adhesions everywhere, but the surgeon was amazing. The next day I told her just that. On my last day, I told her how much getting to know her meant to me and how much I learned from her. And this part I still remember as clearly as ever.
She said “Well?” then threw out her arms and said “Hugs!”
I gave her a hug.

I found out Ms. B had died 7 months later. As abrupt as you felt that now is as abrupt as it felt to me. My resident told me in passing.
She said, “It was weird, but she asked if you were around before she left on hospice. So I thought I’d tell you.”
I had never been more honored, I had never felt more grateful, than in that moment.

I went home later that day. I didn’t really share this story or anything, I actually have never told it. But I got home, and my roommate was there for me in a big way. I remember it clearly.
I walked in and I said, “Hey man.”
He looked up, his headphones on, and said “Hey I’m making spinach and eggs tonight, is that good for you?”
The man makes a mean spinach and eggs.
Sometimes that’s all it takes.

You know in these last years, I’ve seen my classmates and others organize days of fasting for solidarity, letter writing campaigns, courses for ESL at free clinic, tours for all kinds of organizations, create specialty groups from nothing, improve mentorship, take each other out when they think something is going on, make dinners and feed others, make kits for the homeless, it goes on forever.

Some things are devastating for no reason at all. Some things hurt more than they ever should. Most things are just not fair and make no sense. But we are made better by each other. And that’s what that patient taught me. That’s what I think humanism is. It’s not just being kind. It’s not just being compassionate. It’s reaching out. It’s letting people heal you while you heal them. It’s learning. It’s fighting. It’s taking a piece of you and giving it to someone else knowing they will give you a piece of them right back. Just being there can make all the difference. Just showing up. The strength of your presence, of your thereness, means more than you can understand, and it’s important to never forget that.

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