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.