Sad Notes in Medicine

Posted on Oct 2, 2012 in Life of a Medical Student, Life, the Universe, and Everything | 0 comments

When you enter a career in medicine, you’re signing yourself up for a career where you will participate not only in the gratifying role of making someone better, but also in the painful and saddening role of watching someone fail to get better. It’s something (I hope) we all accept in going into it, but that doesn’t make it any less sad.

I was fortunate to have some exposure to death and dying before getting on the emotional roller coaster that is medical school. I met my first dead patient at the age of 15 while I was working as an apprentice on a local ambulance service. In the throes of a dramatic thunderstorm, we found ourselves struggling to extract the 67 year old man from a barn stall shared by his thunder-spooked horse and his now hysterical wife. But before we even started the process, even me in all my naivety could tell by the color of his skin that there was nothing we could do. We transported the man to the tiny local ER, where he was pronounced within a few minutes.

I’ve seen a lot of patients die by now and unfortunately I can’t say I remember them all, but some of them still resonate with me. And I had an experience recently that I’m certain will stay with me for the rest of my life.

On my first day on my neurology rotation I met a patient admitted for a headache who had some odd but nonspecific findings on his MRI. Other than the headache, he was cheerful and active, antsy to get out of the hospital and back to work. He was a physician, and he spent time teaching us about the diagnostic tests we were running on him. All of our tests came back negative. It turns out, that happens more than you’d think on the neurology ward service.

So eventually, the headache seemed to be somewhat better, although not completely resolved, and he was discharged to follow up as an outpatient. He did not improve and, in fact, seemed slightly worse when he came for his appointment, so he was readmitted. Because I’d met him before and I love a good medical mystery, I took him on as my patient. For the next two weeks, we ran more tests and checked for everything we could think of. We were bouncing ideas off most of the medical specialties you can find in a hospital.  I spent hours pulling articles about rare disease presentations and learning about obscure syndromes. We were all coming to the same gut feeling, though, a really bad gut feeling. And we were right, it was ultimately found to be an incredibly rare presentation of an aggressive cancer and the prognosis is very poor.

The wonderful thing about being a medical student is that while the doctors you are working with have to see 15 patients, you’re only following 2 or 3. And so it meant that I got to spent a lot of time with him and his family. In his lucid moments, we talked about genetics, his medical school experience, his son who had spent time in New Hampshire close to where I grew up. And through the experience I witnessed a family go from expecting to go home with their loved one in a few days to realizing that over the course of three short weeks, seemingly without warning, they’d lost him forever.

He was a wonderful man. I’m grateful for the opportunity to be one of the last students of many that he taught and I feel privileged to have been allowed into his family’s life as they went through the heartbreaking ordeal.

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