Monday, May 11, 2015

Medicine rotation: Patient death

In the Med rotation, we have selectives. Selectives are when we follow a bunch of people in the specialisation of our choice around for four days (that's two days a week for two weeks). Much to my excitement, I managed to snag the Oncology selective, which I was really looking forward to. And I was right to look forward to it! Three of the four days are up, and I've enjoyed my time on the Onc ward and sitting in on clinics. The things I've seen and learnt (got to watch a lumbar puncture and a bone marrow aspirate) probably aren't going to be super helpful in terms of our exams in third year, but the exposure to this area of medicine has been invaluable.

Also, the Onc interns are so friendly, helpful, and keen to teach! One of them guided me through my first cannulation today, which went great. They've also let me take notes sometimes, but I kept getting lost and couldn't remember what to write where, so they patiently dictated everything. I really couldn't be more grateful. I'm also for grateful for registrars and consultants who take the time to answer my questions on, well, everything. This selective has shown me how painfully little I know about cancer and its symptoms and treatment. I try to time asking questions such that I don't interrupt things, and I don't think the questions I ask are stupid...but then again, you never know. They're probably used to keeping straight faces while answering hilariously stupid questions from patients.

There have been downers, of course. Today I saw a patient who'd deteriorated a shocking amount since the last time I'd been on the ward a week ago, due to new CNS involvement. Also, today I found out that my favourite patient had died over the weekend.

I know, it's dumb to have a favourite patient, especially since I'm a student and none of the patients are mine. It's dumb, I knew it was dumb, but I took a liking to them.

They were the patient I'd written about in my Ward rounds post, and since then, I'd had them as the patient for a BST (bedside tutorial) and seen/talked to them during this selective. This happened over the last three weeks or so, so I inadvertently kept up with the progression of their disease and its treatment. Exactly a week ago, I was told to examine them, and they helpfully showed me where to place my hand to feel the hard mass in their body. They were smiling and cheerful despite looking quite sick -- it would've been hard not to like them. In addition to that, their spouse reminded me a lot of one of my old Chinese teachers, a fact that endeared the spouse to me also. Needless to say, I was rooting for this patient pretty hard.

Listening to the doctors catch each other up on what had happened over the weekend this morning left me a bit shell-shocked. Things began to proceed as per normal, but the spouse popped up in the middle of ward rounds and spoke to one of the interns for a bit; I heard them telling him to take care, and he was a bit teary-eyed when he rejoined us. When he couldn't hear, the registrar told us he'd take him aside later and speak to him. The intern seemed to have taken it hard, he said, and he was concerned. I can't tell you how glad this made me. You hear over and over again how emotionally taxing this job can be, and it's just so great to know that there are superiors who care enough to have your back.

Mugging away in pre-clinical years, trying to wrap your brain around the pathophysiology of heart disease and memorise the mechanisms of action of a million different drugs, it's so easy to lose sight of the bigger picture. Being on the Medicine rotation has brought back the humanistic aspect of Medicine, and it's reminded me why I'm here doing what I'm doing. Every person I've encountered on this rotation has taught me something, for which I am grateful; my favourite patient taught me lots.

As we were chatting after I'd had a feel of the mass in their body a week ago, my favourite patient told me that they'd seen me around the hospital and remembered me. I beamed and told them I remembered them too. Little did both of us know, this would hold true always. Everyone remembers their first experience with patient death, right? I'm pretty sure I always will.

Rest in peace, favourite patient. Thankyou for everything.

P.S. My not using the names of the interns was a conscious decision; it was meant to deidentify, not depersonalise.

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