The year was 1997, and I was an intern. I remember the morning vividly. Rounds had ended, the nurses had just started their shifts. The hospital was hustling. I felt a buzzing sound and looked down to see a page from my mother, then another and another. The frantic paging made my heart race and I wondered what could possibly be wrong. I ran to the nearest phone and heard my mother’s voice. She was crying. My grandmother had called her and she could not understand her. My mother panicked and called 911 worried she was having a stroke. My grandmother was 76 years old and suffered from a labile diabetes resulting in many visits to the hospital. I didn’t know what to say. I was post-call and exhausted. I explained to my attending what was happening and raced over to meet my mom at the hospital.
When I arrived, my grandmother was in a regular room with a blank stare and she wasn’t moving. My grandmother had had a stroke. I couldn’t believe it. I stared at her and with my limited medical knowledge couldn’t understand why she was in a regular room. Her chart even had an order for a regular diet! I remember thinking: A regular diet? She can’t talk! She can’t swallow! She needs to be in the ICU.
I was the first doctor in my family, and everyone was looking to me for answers. I was 25 and I was scared. Yes, I graduated from medical school but I didn’t really know how to manage a patient on my own … not really. Yet, I felt I owed my grandmother the care that she deserved and I demanded that the nurse page the doctor. Minutes later the nurse called me over to tell me the doctor was on the phone.
As soon as I heard his voice, I began to scream. “Why is my grandmother on a regular floor?” “Why isn’t she in the ICU?” “Why has she not been seen by any doctor on the floor?” “Why does she have a regular diet ordered?” On the other side of the line was an impatient voice. He asked me if my grandmother wasn’t always this way.
”What do you mean?” I said.
“Yes,” he said, “isn’t she always like this?”
No! I visited my grandmother yesterday! She was walking, talking and smiling. This is not my grandmother. The body laying on the bed had a blank stare. The body was rigid and unresponsive to my touch. “No!” I yelled. “My grandmother had a stroke! Don’t you see it? Don’t you care? She needs to be in the ICU.” Then, I heard the yelling on the other side of the phone. The doctor yelled back at me and said, “Do you want to make her a DNR?”
What? I couldn’t believe it. Did this guy go to medical school? Did he take an ethics class? Did he take a death and dying class like I did? He was really asking me if I wanted to make my grandmother a DNR over the phone while yelling at me. At that moment, I felt the rage inside of me. I knew very well what my grandmother wanted. She had an advance directive and made sure everyone in the family knew what she wanted under all circumstances. She was a realist and she prepared us. She knew this day would come and she wanted to make it as easy as she could for us. That was my grandmother.
“No!” I yelled back. “I do not want to make her a DNR!. I want her in the ICU and I want her treated as a patient that has had a stroke!” I hung up the phone. I sat there in disbelief. I walked back to the room and waited. No one was talking. Suddenly the doctor walked in with nurses by his side. He examined my grandmother. I couldn’t look at him. I was scared, angry, hurt and so incredibly confused. When did the system harden him? When did he stop caring? When did the patient stop being a patient and become just a number on his list?
After he examined my grandmother he looked at me and said, “Sorry.” The truth is I didn’t even hear it.
It wasn’t until recently that I even remembered his apology. I remember I looked past him and I told him I did not want him to ever touch my grandmother. I told him he did not deserve to be her doctor. I demanded that another doctor be assigned to her and he just walked away.
My grandmother was transferred to the ICU and treated like a stroke patient. She never fully recovered and was wheelchair bound after that. She regained some of her mobility but was very limited in what she could say and do. She worked hard during physical therapy to regain as much of her strength as she could. My grandmother was the matriarch of the family. She was the one that always encouraged me to go to medical school. She loved medicine, and I truly believe that she would have been a doctor if she was born in a different time. She was everything to us.
I finished my residency in pediatrics in 2000 and have been practicing since then. My grandmother passed away in 2001, and I miss her every day. I often wonder what happened to that doctor. I wonder what he is doing and if he is still practicing. I wonder if I changed him. I hope so. I hope he stopped and realized that he had the power to help or hurt. I hope that he chose to help. He is the one that reminded me of the importance of caring. He is the one that encouraged me to be the opposite of him.
Every day when I see patients, I try to imagine what it is like to be in their shoes. When I am in the exam room with a patient, it is just my soul and theirs. There is no color, culture or ethnicity that divides us. Patients tell me how they really feel and I have learned to look past some of the anger or indifference they show on the outside. I know that, usually, that anger is a defense mechanism for the fear they have inside. When your loved one is sick, it is terrifying. Not knowing what the outcome will be is awful. I know that I do not always know all of the answers. I do know that I always try to put myself in their place. I know what it is like to be scared.
The truth is that empathy is what separates us from any computer or machine making a diagnosis on a patient. Empathy is what we need when we feel scared and alone with a diagnosis. Medicine has changed a great deal and I see how technology and computers have pulled us away from the patient. I hope the new doctors realize that in the end, the only thing that makes us special and better than a computer is our heart.
Elizabeth Vainder is a pediatrician who blogs at DRVCARES.
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