American Medical Student Association

A bowl of cereal ruined one day in recent memory. Another was compromised specifically by a bagel with cream cheese. The nurse on the other end of the line always feels obligated to tell me exactly what my patient ate for breakfast when he was supposed to have nothing by mouth after midnight in preparation for surgery. For whatever reason, it’s not enough for her to say, “Dr. Firlik, we have to put your case on hold for three hours. Mr. So-and-so had something to eat.” At least then I wouldn’t have to hear that it was Grape-Nuts or a sesame bagel. Such finer details could be left to my imagination as I sit in the surgeon’s lounge in my scrubs, staring at the television bolted to the wall and contemplating my wasted morning.


One breakfast transgression by one patient shifts my whole day and threatens to land me at home late. I wonder whether my friends in business or law are ever paralyzed by something so humble as a bowl of shredded wheat. It would be unfair to blame the patient, so I don’t. So many patients these days are elderly and forgetful and live alone. Regardless, mornings like this reinforce my belief in the adage familiar to all physicians: It only takes one patient to ruin your day. A physician may see 20 patients in a given day, but only one is required to take up those extra hours and make us miss a dinner engagement, or keep us in the hospital on Thanksgiving, or even, as a bonus, reward us with a frivolous lawsuit. But this is what I signed up for when I decided to become a surgeon.


On occasion, my day is hobbled by just one patient with just one simple request, typically while I’m out for dinner or a movie and typically on a Friday evening. The patient is in excruciating pain—the worst pain of her life, in fact. She demands that the hospital operator page me because she suddenly finds herself out of Percocet after regular working hours. She needs more. She offers one of the following reasons, in a groan: A) her handbag, containing the full bottle of pills, was stolen; B) the pills accidentally got flushed down the toilet, or—a common variant—her boyfriend flushed them down on purpose; C) her teenage son stole them out of the bathroom cabinet; or D) she accidentally left them behind in a hotel room.


Those are the stories, in descending order of popularity, I hear from patients who assume I’ve never heard those stories before. Sometimes the patient will have me paged again, even after I’ve explained our no-refills-after-hours policy. Some will even go so far as to call me back directly, once they’ve captured my cell phone number. At that point, I have to decide how long I’ll endure the soliloquy before I hang up. As I said, it only takes one patient and, often, it only takes one little thing. A bowl of cereal. A bottle of narcotics.


Just as often, though, it only takes one patient, and one little thing, to make my day. I took care of a woman who had seriously injured both frontal lobes in a fall. Her husband visited her every day, and I often saw him at the bedside during my evening rounds. He tried his best to engage her in conversation despite the profound lobotomy-like apathy that her swollen frontal lobes returned to him. It was torture for him—and me—to watch. One evening, I eavesdropped on their “conversation” while I worked at the back of her head to remove a few sutures. While he held her hand, he spoke softly and patiently of his day at work, the weather and current events. “What a great guy,” I thought to myself. “What a strong marriage.”


Then he mentioned to her how he arrived home alone the other night and decided to clean out her purse. “Just the way you like to do,” he told her. “I got rid of all the gum wrappers at the bottom.” It was his mention of the gum wrappers that really got to me. I had to excuse myself. Standing out in the hallway, I dabbed my eyes and took a deep breath before going back in the room. It was the simple gum wrappers.


Not long ago, I saw an elderly woman as a consult in the hospital. Her internist ordered a brain scan to evaluate her rapid decline in memory and speech. She already had mild Alzheimer’s, but this was something more. I took one look at the scan and knew the answer: malignant brain tumor. Sure, I explained to her internist, we can be fooled on rare occasion. Sometimes it turns out to be something else, like an abscess or a more benign type of tumor. That’s why we usually recommend at least a needle biopsy. Otherwise, we can’t offer any treatment.


I went through this thinking with the patient and her daughter. They asked me for some time to think about it. A few hours later, I received a phone call from the daughter. They appreciated my advice but they decided to leave things be. “She’s had a full life,” her daughter explained.


Although I had nothing left to offer, I stopped by her room again on my evening rounds. The patient’s entire family was there, and her daughter was pouring champagne.


“We’re toasting to her life!” the daughter told me. The patient laughed. She was the happiest patient I had seen all day, despite being the closest to death. She smiled and offered me a glass.