There she lay: a 59-year old woman who had become increasingly disoriented and confused. Not only did she have an infection in her bloodstream, years of alcohol abuse had taken its toll on her liver, leaving her skin yellowed.
“Welcome to the ICU,” I thought. In contrast to my previous clinical experience, I found this patient encounter unsettling.
She was nothing more than a body in a bed punctured with lines carrying various fluids from hanging bangs.
A few day later, one of her family members shared with me a newspaper article featuring her. The picture of a vibrant and young woman shocked me. In another life, she had been the captain of her collegiate athletics team.
Every day, I made it my responsibility to share the article with others. Though her poor prognosis did not change, neither did her personhood.
Her family accepted palliative care, so she was transferred off the unit. About a week later, she passed peacefully.
She no longer existed in a physical sense having breathed her last breath, but her personhood persisted. Her family wanted me to hold on to that article.
As a medical student, I frequently felt that my presence served no purpose, but that encounter reminded me of an early privilege often overlooked at an early level of training: the opportunity to appreciate the patient narrative.
This idea mirrors a concept in physics featured on an episode of NPR’s Invisibilia podcast entitled, “Entanglement.” Entanglement occurs when a pair of atoms hit with a laser beam split into subsequent pairs of atoms. Altering one atom in these pairs affects the other even when separated by miles.
Like those atoms, the narratives of patients I encounter will forever affect me even when separated by the passage of time.
For that reason, I remember an elderly woman who had initially been hospitalized for pneumonia. During her hospitalization, she continued dialysis for her kidney failure, but at her appointment, she fainted. Her blood pressure had dropped dangerously low. Given the concern for a bloodborne infection, she was admitted to the ICU.
The first day I saw her, she appeared disoriented. Her thin, frail body lay crouched over to one side of the bed. She had lines as well but no tube in her throat as she struggled with each breath.
In her medical record, we found a document that stated that she did not want any interventions, like CPR or a ventilator. However, her son had recently declared her unfit to make that judgment and wanted these interventions.
Given the complexity of her conditions, several doctors coordinated her treatment, and they were unanimous in their belief that such interventions would do more harm than good.
On rounds, we initially didn’t have a good explanation for her disorientation, but given her heart failure, we considered that her incident the day prior may have just been a sign of the heart unable to tolerate continued activity.
The next day, her disorientation had improved. She still struggled with breathing but could mutter a few words intermittently.
The attending physician met with her son to discuss his mother’s prognosis. The attending presented two possibilities that every caregiver faces in this situation: to pursue aggressive measures or to pursue supportive measures.
With tears in his eyes, I could sense his conflict.
He wanted her to live.
He wanted aggressive measures.
He wanted to act in his mother’s best interest.
Slowly but surely, he realized supporting her didn’t have to mean giving up. Rather, it meant the triumph of her wishes.
In the early hours of the next day, she passed quietly.
Her narrative is forever entangled with mine; she left this world on the day I entered it, my birthday.
My identity as a physician will forever be molded by my experiences with patients. I couldn’t be any more thankful for it.
Rushil Patel is a medical student who blogs at his self-titled site, Rushil Patel.