10 months into third year, and I have not yet had a patient die. To be sure, patients have died while I have been on service, but they were never my patients (the unfortunate few who have to deal with me rounding on them, in addition to the intern, the upper level resident, the attending, and the specialist teams). And I've been on teams where patients have grim prognoses, but they have never been my patients. In fact, I've never been responsible for a patient from the minute they begin the "bad news" journey. And you know where this is going. That is, of course, I've never had that patient until today.
I have a new patient. And I love him. And his cancer has gobbled up his spine. It is the quintessential medical school experience. You walk in to begin your assigned "History and Physical," and the patient, lying in a cervical spine collar says after you apologize for being "just the medical student," "Oh good, someone to talk to." And so you spend an hour talking with him and becoming attached yourself as the grim prognosis begins to take shape. And you check in frequently throughout the day because there is no family, and because, frankly, the patient compliments you on your bedside manner in front of the resident which feels good, and it's hard in these situations to make the experience about the patient and not yourself because really this is all so new and enormous for you, too, and...
...And you catch glimpses of him staring at the ceiling (can't they paint the ceiling tiles like they do in pediatrics? Maybe reproductions of Monet masterpieces?), trying to tune out his neighbor's incessant beeping and parade of visitors who talk too loud and play with cell phones and stare at him as they walk by. And you wonder what he thinks about, because really, we all secretly wonder what that moment is like. The moment you learn what shape your demise will take...
...And you go home expecting to cry but the tears that never came in psychiatry won't come now. And there is a solution that is not reassuring the patient or minimizing the truth. The biggest lesson I've learned from the Palliative Care team is that quickly the decision must turn to meaning. What does this all mean? And not in terms of explanation, but fulfillment or significance. Not even legacy, because there's too much pressure for greatness in a legacy. How to turn this man's experience into a meaning such that I can continue to shoulder my responsibility? How not to focus on my inability to fix and to cure? How, simply, do I attend to comfort?
And that's the point. Comfort. The meaning is the drive to provide the best care I can, to be the best I can be. That's the meaning. I can't win, but I can play well and grow. I wonder what his meaning will be, what significance there is to be had.
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