The Other Patient
The man at the bedside was suffering tooThe New Physician
There were two: one lying on a hospital bed, the other standing by his side.
I had the good fortune of meeting both on my second night on call for the medicine service at the VA medical center in Oklahoma City. I had spent what felt like 24 hours in the ER, but in reality, I had only been there around two and a half. I was tired. Everyone was tired. Patients appeared to be everywhere—some sitting in wheelchairs, some lying on gurneys, all trying to stay out of the way of the busy shuffle. It seemed the addition of one more patient would surely be a violation of the fire code.
After I got the call to see Mr. F., I found my way to his glassed-in bay and peered through the slit between the curtains. While I stood there, I contemplated what my resident had told me about him: “67-year-old white male with a history of multiple myeloma who is here for nausea, vomiting and diarrhea.” After spending the better part of two or three minutes striving to remember the details of the pathophysiology of multiple myeloma, I pushed back the curtain and entered his bay.
He looked uncomfortable. He was lying on his left side, neck flexed, head almost off the pillow and eyes staring into space. I introduced myself in the usual fashion, indicating that I was a student and that I would like to visit for a while and hear about what had brought him to the ER on this particular occasion. Having earlier read the brief note written by the ER physician, I was well aware that getting my 101 questions answered in the full detail I had come to expect would be more of a chore than usual, as my new patient had suffered a stroke that had affected his “word finding” ability.
I shook my new patient’s hand, then turned and introduced myself to the other man in the room. When he replied, his eyes gave away their relationship more so than any of the words he spoke: He was the patient’s brother.
My questions and our conversation eventually allowed me to learn a significant amount about my new patient. He lived alone in Oklahoma City and had done so his entire life. Because of his stroke, he had been placed on full disability and could no longer program computers as he once had.
With careful attention to his medical history, I learned the cancer was bad. It had spread throughout his entire vertebral column. In the previous year, he had undergone a stem cell transplant and received chemotherapeutic drugs I could not even pronounce. Throughout his tribulations, his brother had been by his side, close enough for security but far enough to offer a sense of independence. He checked on his brother daily, and on bad days, such as the one being suffered today, he took extra time and helped him get to the doctor.
My exam had to be performed with careful detail. I needed to correlate a five-day history of fever, nausea, vomiting, neck pain and headache with physical findings to arrive at some conclusion about what was causing my new patient his obvious discomfort. Possible diagnoses raced through my mind with each exam finding.
Pain was a recurring theme. Barely moving at all, my new patient winced in discomfort while he searched for the words to tell me what he was feeling. Often, no words came at all. As I scrutinized from head to toe, the patient’s brother stood by the bedside as a spectator. His hands rested on the bed rails. After every maneuver, he looked at me and his eyes asked, “What does that mean?” I did my best to explain what I was seeing with each palpation, percussion and auscultation. When I finished, I thanked them both for their patience and willingness to share their problems with me.
As I began to walk out of the room, it was evident by the apprehension worn on his face that my new patient’s brother was worried. He forced a smile and stood there with his hands tucked into the front pockets of his jeans. He did not say a word. In the brief awkwardness of the moment, I thought, “How could I, as a third-year medical student, bring any comfort to a man who had seen his loved one suffer more in the last four years than many do in a lifetime?” My skills as a young physician were novice at best.
I was not sure of any diagnosis. Nor was I certain in what direction the treatment plan was going to go. But I realized that what I could do was listen to his questions, keep him informed, and do my best to explain to him in simple terms what would come next for his brother.
And this is exactly what he wanted. He didn’t expect any Oslerian feats of medicine to be performed right there in the ER bay. Rather, he wanted someone to recognize that while his brother was aching from disease, he was aching with an immense amount of empathy for his closest companion.
My brief career had been filled up to that point with countless lessons in medicine that emphasized pathophysiology, treatment and prognosis. I realized that night that there is sometimes more than one patient, and being a compassionate doctor is truly about good “patient care” for all of them.
Gary Schooler is a fourth-year at Oklahoma University Health Sciences Center.
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