Stoicism (n). The endurance of pain or hardship without the display of feelings and without complaint. It is the art of disguise, the very definition of dissonance, a faceless marble statue of emotion.
Anxious (adj). Experiencing worry, unease, or nervousness, typically about an imminent event or something with an uncertain outcome. It is a description of a rising sense of uncertainty deep within the core, threatening to bubble to the surface.
And then, there is everything else in between. The mother clutching her newborn child close to her chest, worry evident in her brow. The elderly gentleman staring out the small Bellevue window in silence after hearing his worst fear had come true, a diagnosis of malignancy. The young adult, sitting alone in the busy emergency room, waiting for an opening in the already bustling and dynamic hospital. And then there was me, a tentative clerkship student, entering through what seemed like enormous hospital doors, just hoping to aid this huge array of individuals.
Young or old, stoic, or anxious, everyone arrives at the hospital with one goal in mind – to alleviate. Health care practitioners who wish to alleviate their patients’ symptoms, patients who wish to alleviate their unknown worries, and families who wish to alleviate and support their loved ones. This want to alleviate is something that I quickly learned from Ms. R as a medical student in internal medicine.
Every morning, I would walk into Ms. R’s room after reviewing the events the night before, ready to discuss with her how she felt that day. A 49-year-old woman who had arrived septic with Klebsiella pneumoniae bacteremia, with the source identified incidentally with a computerized tomography scan of her abdomen – a liver abscess. I would check on her every day. She was my first patient, someone I felt intrinsically connected with.
But over time after being stabilized, the interdisciplinary team taking care of her eventually would shake their head when discussing her case. She refused to talk with certain physicians, nurses, or staff and adamantly requested to continue staying in the hospital. The social work team worked hard to obtain a rehabilitation program for her, but she denied all offers. And day by day, the need for discharge grew. Suddenly, I found myself at her bedside with physicians, social workers, and patient advocates, watching as they discussed the need for her discharge. Her expression gnawed at me. When the meeting was over, I followed my team out, glancing behind me at her frustrated expression.
The hospital flow continued to ambulate around me, rapid response teams rushing past to get to the room next to me and the hospital staff busily administering medications. I continued my responsibility as well, trying to embody the role of a student dedicated to learning. But her expression continued to imprint on me.
I stepped out of the workroom, quickly heading to room 1453. I stopped in front of her door, staring at the sign that was placed on it “do not enter until after 11:00 AM” as per her request. Tentatively, I announced myself to Ms. R, peeking through the curtain. Her pink pajama pants were rolled up and she was staring intently at her hands. Upon entering, she glanced up at me, tears welling in her eyes. I pulled up a chair next to her bed.
As I looked for something to say, I realized I did not know her reasoning behind her discharge refusal. Lightly touching her shin in reassurance, I asked “Ms. R, why do you not want to go home?”
“I don’t know how to take care of myself. I’m in pain, and I don’t know how to do anything.” She was scared. She was worried about the unknown. She believed that administering her IV antibiotic alone in her home would be near impossible, and it would be too complicated for her to do it correctly.
“Ms. R, how about I show you what it would look like? I think you might see that it is simpler than you think.”
As we talked, I watched as the furrow in her brow slowly softened. A hint of a smile behind her tired face arose to the surface, and I sat with her, continuing to answer her questions. I realized then that she had not been given enough time to discuss the whirlwind of what had happened to her at the hospital. She had come in incredibly sick and treated in the intensive care unit for her ketoacidosis. She was one of the many that got caught up in triage, a woman now lower on the priority list amongst a sea of pneumonias, bleeds, and cardiac complications.
As a medical student, I realized I was lucky to have the luxury of something scarce. I had time. I could spend it with her, and I could help her in this small way.
Stoicism (n). An art of disguise, the very definition of dissonance, a faceless marble statue of emotion.
Anxious (adj). A rising sense of uncertainty deep within the core, threatening to bubble to the surface.
For Ms. R, she was a patient labeled as the latter. A patient who is colloquially known as “a difficult patient.” Abrasive, loud, and worried. But behind each patient is a reason, and behind each reason is the answer. She reflected me, a mirror to my frenetic workflow as a medical student, too tunneled on writing notes and preparing presentations. But in this moment, she was a reminder; she was a recognition of the innate need for human contact in an environment that is often frightening to patients.
Ms. R hugged me. “Thank you doctor. I want to go home.” Although I am far away from being the physician I wish to be at this stage in my training, in that one instance, I felt just one step closer to truly being a doctor. I hugged her back, remaining stoic. But inside, I could not stop smiling.