What spending time with critically ill patients taught me

A hospital is not the homiest of establishments. The bright neon lights, strange smells and piercing high-pitched beeps that radiate from the rooms of dormant patients fill the halls in a symphony of annoying sensory stimulation. But to someone recovering from a relationship that just ended, hospitals are heavenly. When the lonely silence of your one bedroom apartment is overwhelmingly loud, beeping IV lines and incoherent mumbles are surprisingly therapeutic.

As a physician or medical student, we have a responsibility to compartmentalize our lives and provide each patient our undivided attention. But like a speck of gathered dust on my unclean glasses, reminders of my dissolved relationship were annoyingly ever present.

My patient on our first day of pediatrics was a 15-year-old, let’s call him “Joe,” who boasted a terribly tragic and challengingly complex medical history and hospital course. With a formerly abusive, currently deceased father, and a mother sadly addicted to meth, his childhood — populated by multiple suicide attempts and run-ins with the law — was anything but normal.

In a seemingly inexplicable course of events, a stubbed toe from a skateboarding accident led him to a podiatrist for a steroid injection to mitigate his pain. This introduced an inoculation of bacteria into his bloodstream, eventually leading to sepsis and acute respiratory distress as the malicious bacteria multiplied throughout his frail, teenage body. Joe’s breathing continued to worsen and he was put on ECMO, a method by which blood is drained from the venous system, oxygenated outside of the body and returned for tissue delivery, bypassing the lungs entirely.

Regrettably during this procedure, his femoral nerve was compromised resulting in permanent nerve damage and decreased lower leg mobility. After a month long medically induced coma, his lungs recovered and Joe was finally stable enough to leave the hospital and enter physical rehab. Unfortunately a few days later he was readmitted for uncontrolled nausea and vomiting, which is when I had the opportunity to meet him for the first time.

“Don’t choose that patient,” my resident said. “He is rude, complicated, and may be a drug seeker.”

As a medical student new to inpatient medicine, Joe’s medical history was vast and overwhelming, but I decided to take the plunge.

As we walked up to Joe’s bed on our first morning rounds, he did not embody the stereotypical drug seeker image molded by my preconceived notions. A thin boy with floppy brown hair sporting a conniving smirk greeted our team, just an average high school kid to the uninformed eye.

As the days progressed, I visited Joe each afternoon to chat. Speaking with him really put my sadness into perspective. He had experienced the equivalent of a 42-car pile up. And me? Just a minor fender bender.

We became closer, and Joe told me the story of how in his sepsis-induced stupor preparing to die, he whispered to his sobbing 11-year-old brother that everything was going to be okay, even if he didn’t make it. He described how his grandparents eventually agreed to take him in again and give him a second chance, since God gave him a second chance at life. And through these stories I realized that in some ways, he is mature beyond his years, and no matter how upset I may be, I am unimaginably fortunate.

Spending time with critically ill patients shines a spotlight on the uncomfortable truth of how fragile and fleeting human life can be. Amidst the terrible diseases threatening patient mortality that comprise the haystack of inpatient problems, surely a simple broken heart is the proverbial hidden needle. We normally don’t think of a hospital as a place where patients can provide therapy to their healthcare providers, but in my case this was a blissful reality. For getting my mind off of my personal life, talking with Joe was certainly the drug of choice.

There are mountains of frustrations that compromise the medical system’s delivery of care. Medical record requests through anachronistic fax machines that put patients at risk of excess testing, and mind-numbingly frustrating bureaucracy are urgently in need of real reform. Yet all these frustrations are trumped by our unique opportunity to enter the sacred world of a patient’s battle with death, to stand on the side of modern medicine as it grapples with the threat of grim reaper’s scythe.

The long hours and accrued debt suddenly seem worthwhile when that one patient in need looks deep into my eyes and conveys their genuine gratitude through two simple words. That bone-tingling fulfillment that crawls over me when “thank you” comes out of their mouth is the ultimate reward. Joe reminded me of this when I needed it most and for that, I’d like to return the favor: thank you, Joe.

Larry Istrail is a medical student. He is co-founder, PhotoCalorie, and founder, Ancestral Weight Loss Registry.

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