Who We Really Are

When I was a resident in radiation oncology, I thought I already knew a lot about medicine.  After all, I had just completed an internal medicine residency, and had taken and passed my boards.  Needless to say, I was more than a little bit irritated the first time a patient “coded” in the radiation therapy department and I was shoved out of the way by the intern on the code team.  After all, he was an internal medicine intern at the World’s Greatest Hospital, and I was a lowly radiation oncology resident. My protestations of “I can HANDLE THIS!” were lost in the general hubbub of excitement and confusion surrounding a cardiac arrest.  The patient survived, despite my bruised ego.

I found out very quickly that I didn’t know much at all—in fact, I didn’t know how to write a proper history and physical.  On my first rotation, my attending corrected my very first sentence, stating emphatically that “Mr. So and So is NOT just an 86 year old Caucasian male who presents with lung cancer. He is an 86 year old retired firefighter and grandfather of eight who presents with lung cancer.  There is a big difference.  You will see!”  From that point on, I was charged with adding descriptors beyond the age, sex and race of my patient so that I would know that patient as a PERSON, and not just as a disease.

My daughter is going through her internal medicine residency right now.  I remember how easy it was to de-humanize a patient by calling her “the myocardial infarct in ER bed 8”, or the “renal failure in 222”, or the “nursing home placement on the 9th floor”.   If we call them by their disease, they cease to be the living breathing mother of high school age twins, or the father of a disabled son, or the principle of the local school for the deaf.  They’re just diseases, to be treated and discharged, or “buffed and turfed” in the old House of God parlance.  It’s much easier to be detached from a disease, than from a human being that one might just have something in common with.

Because of my first radiation oncology attending, to whom I will be forever grateful, I’ve made a point to pay attention to the person, and not just the disease.  I teach my medical students the same thing—that it’s not enough to just copy and paste the social history—the history of whether the patient is married, has a profession, has children, smokes or drinks alcohol or takes her religion seriously.  I try to learn about the person, and when I do, and convey that to my entire team of physicists, therapists, nurses and front office, I know that the patient gets better care.  It’s just human nature to empathize, and sympathize, if we truly know the human being behind the diagnosis. And it’s especially true for the difficult patients, the mean and angry ones, the ones we would prefer to dismiss.

But sometimes I slip up.  Recently I treated an elderly man postoperatively for rectal cancer.  He was a quiet elderly gentleman, but his son, a tech writer, made everyone in the department miserable with his demands for his father.  I never asked the man what he used to do, before he was eighty six with rectal cancer.  But another one of my patients was a little more curious.  He and the old man were side by side in the waiting room day after day of treatment until finally, the younger man asked me, “Where is Mr. __ from?  I can’t place his accent.”  I said, “I don’t know—I suspect he might be German but I never asked.”  So I did ask.  And was surprised to find out that my elderly patient was Israeli, born in 1925 in what was then Palestine. A true “sabra.”  He grew up in the Holy Land to become one of Israel’s foremost songwriters.  In fact, they still play his songs in Israel and recordings are available on YouTube. And I would never have known that if another patient had not cared enough to ask.

When you and I get sick, as we almost certainly will, we should all hope that our histories state who we really are, and that our admitting interns and residents care enough to ask.  They will be better doctors if they do, and we will get better care.

Back to the Future

I am in Houston, Texas today—the place where I grew up.  From the moment I got off the plane on Wednesday, I had a strong sense of déjà vu—the small town feel of Hobby Airport, the banners welcoming me to the Houston Fat Stock Show and Rodeo, the drive to the Texas Medical Center where I visited my Dad at his office as a child.  But there is no possible sense of déjà vu more powerful than I felt today, in the sunny courtyard of my former medical school, waiting for the results of “The Match” to be unveiled.  For those of my readers who are not doctors, and who do not come from medical families, the Ides of March is the day that every fourth year medical student in the country finds out where they are going to do their residency.  Earlier in the year, aspiring internists, pediatricians, surgeons and obstetricians applied for internships and residencies, interviewed and finally made a list, in order of preference, of programs they wished fervently to attend.  Residency programs did the same, for students they fervently wished to attract.  And then a computer program called the National Residency Matching Program did its thing.  Today at precisely 12 pm EST, the results were announced in a white envelope.  The tension, as they say, was palpable.

 

Exactly 34 years ago today, I stood in the same place as my daughter stood today and felt my life change.  I would be leaving my hometown, my boyfriend, and last but not least my dog, to move to a city where I knew absolutely no one, because I had been given the gift of an opportunity to do my internal medicine residency at Boston’s Beth Israel Hospital, now known as Beth Israel-Deaconess Medical Center, one of the three Harvard training programs in internal medicine.  While I was there, I learned to practice medicine from some of the finest teachers and clinicians I have ever met, people who remain friends and mentors to this day.  I met my best friends, I married my husband, I got my first Scottish deerhound and I had my three children there in that order.  I hated the cold weather, but I loved the values which were instilled in me there, and which I hold to this day—in medicine, the patient always comes first;  family and tradition are paramount, and the Red Sox must ALWAYS beat the Yankees.

 

At 11:02 today Central Standard Time, the waiting and the culmination of four hard years ended.  My daughter opened her envelope and learned that she too would be headed for Boston, to the same place her father and I met so many years ago.  I think she was very pleased.  As for me—well, I did what any proud parent would do.  I beamed, took a picture, and burst into tears.   Well done, Alex, and I hope I didn’t embarrass you too much!