August 1, 2010 6 Comments
I am finally getting a chance to sit down and open up Kitchen Table Wisdom, a book of short excerpts on life by Rachel Remen. Her stories bring to my memory all of the small pearls which my patients have to offer. I have walked away from many patient encounters left with a sense of wonder. Each patient has a story, and as a physician I have the privilege of listening to that story. I still remember walking into the hospital for the first time as a medical student, many years ago. I had shadowed a couple of times before medical school, but not nearly enough for me to make any lasting impressions of the hospital or to feel comfortable there. No – my most memorable experiences in the hospital had been my own. As a young child, I was in the hospital for a few nights here and there. But, since the age of five or so, I had managed to avoid hospitals – and, for the most part, doctors in general. I often even avoided writing down any medical problems on my basic history and physical exam records for school. Interestingly, that approach to life had somehow landed me here – in the hospital, as a medical student and aspiring physician. I still have not figured that one out.
I walked in to the hospital, more nervous than I had ever been before. Short white coat, stethoscope, freshly sharpened pencils in my pocket. I kept thinking to myself, over and over again, Who am I? The image I had seen in the mirror only minutes before was of a stranger. I’m not a doctor, I remember thinking. I will never really be a doctor. And, to some extent, I hope that is true. I hope that I have not lost my identity as a person, or as a patient, solely because my role in the hospital has changed. I strive to be a doctor who understands what it is like to be a patient. Although that becomes more difficult as time goes on, my patients help me to do this every day.
I remember vividly my very first patient in the hospital. She was a young girl with diabetes who had had multiple recent admissions to the hospital for diabetic ketoacidosis. By not taking her medications faithfully, she constantly wound up in a situation where glucose was coursing through her blood but could not get to her vital organs because she lacked insulin, the hormone that allows cells to take in glucose. As a response, her body went into crisis mode, producing ketones and a resulting acidosis that could be deadly.
I had a long discussion with her about her illness. I listened and asked questions – I had nothing else to offer her, as I had just started my classes in medical school and barely even understood her disease. She understood it well. I remember being impressed, even surprised, by that – here I was, a medical student with years of education beyond high school, learning about diabetes from a high school student. I continue to be amazed by how well people understand their bodies – and their illnesses. Ever since this conversation with my first patient, I have never underestimated that.
She taught me about some of the struggles she faced while growing up with a lifelong illness. Everything that was simple for the people around her, family, friends, classmates – like eating ice cream cake at a birthday party, or going for hours on end without food while on a long bus trip to a museum – was not so easy for her. She was becoming frustrated and wanted to give up on following a strict regimen. I could hardly blame her. The problem was that, in the process, she was putting herself in grave danger, time and time again. The problem was that, as much as she wanted to live like a “normal” person, she could not.
I wished I could do something for her – take the pain away, ease her burden, provide her with the right words so that she would feel inspired to take care of herself again. But all I could do was listen to to her. She knew far more about her life and her illness than I ever would. She taught me a lesson which would stay with me for years to come: illness is a personal experience, and in order to truly care for patients, you cannot simply treat the disease – you must treat the illness. You must let the patient guide your approach. And you must listen – because their words are not something that textbooks can recreate, and it is often within their words that lie the answers to what kind of care – medical or otherwise – they seek.