Wordplay

By Nicky Herrick, MS4

Vanilla_ice_cream2

As with all writing published on Stories in Medicine, locations and names in this piece have been changed.

My first day of medicine wards my resident assigned me to Ms. R. “She’ll be a great learning case, autoimmune hepatitis on the transplant list. But, she’s Spanish speaking only, is that okay?”

I was working on my Spanish, Ms. R on her English, but neither of us were very good yet. I used a translator for the daily medical questions, but we practiced with each other on everything else

“Mi hija esta visitando hoy,” she said one Saturday morning with a big smile. We laughed together when one morning I called her liver helado (ice cream) instead of higado.

As my weeks caring for her progressed, I discovered her life outside of the hospital – she was a loving mother, sister, and wife. I met her husband, daughter, three sisters, and two brothers-in-law. Her husband told me how they spend half the year in Alaska, making their living on a fishing boat. These were her precious few months at home, and Ms. R was desperate to get out of the hospital and spend time with her 15-year-old daughter.

I relished my new responsibility as the primary contact between Ms. R and her family. I finally felt like I was the doctor. She and her family listened attentively when I explained what our next steps were, how the new medication worked, and what our long-term goals would be. We shared in the joy when she made progress and maintained hope when she had a bad day.

I will never forget Ms. R and her family, but it was her husband, Mr. R, who taught me the most important thing I learned in medical school.

My fourth week caring for Ms. R, she decompensated. Two days prior we were discharge planning, then suddenly she was encephalopathic, febrile, and maxed out on antibiotics. I talked to Mr. R about how we were looking for a source for her infection and trying to make her strong enough for transplant.

He looked down, took a breath, and quietly asked, “She isn’t strong enough to wait for a transplant at home?”. I explained how it was safer for her in the hospital and that we still had a lot of progress to make before she would be strong enough to go home.

I went back to check on Ms. R later that afternoon. Her husband was there, but not in his normal chair next to her bed. He was holding her leg mimicking the exercises the physical therapist had performed the day before. The realization hit me that just a few hours prior I had explained to him that she needed to get stronger before she could go home. Now here he was, doing what he could to help her get stronger.

Mr. R taught me more about the power of our words in that moment than a lifetime of reading could have. As physicians, patients look to us for guidance and support, and I hadn’t fully appreciated until then that they often they take what we say at face value. When I said she needed to get stronger, I meant everything from finding the source of and treating her infection, to improving her mental status, to removing the Foley catheter, and finally getting her strong enough to get out of bed. But, what I said was ‘stronger’ and to Mr. R that meant to make her muscles stronger, and that was something he could help with.  My interaction with Mr. R taught me first hand that what we choose to say, and how we say it, matters.

The moment was equally beautiful and heartbreaking, and moved me to my core (the next few minutes were spent in the stairwell crying). I collected myself and went back to thank Mr. R for his help with her physical therapy and talked to him in more detail about the many hurdles that she was facing.

After 4 weeks caring for Ms. R, she was transferred to the ICU the day I was off-service taking my Shelf exam. Three days later, surrounded by her family, Ms. R died peacefully.

I always smile and think of her when I see an Alaska license plate or yet again mistakenly ask a patient about a painful helado. Though her case was emotionally and mentally challenging, it was a privilege taking care of and knowing Ms. R and her family.