I will make a concerted effort every day to do my job with love

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Since beginning my medical education, I had been on one side of the curtain; the side where the doctors confer and discuss before telling the patient his or her fate, going from room to room giving updates and prognoses. I interacted with patients for the purpose of getting their histories and physical examinations, collecting all the data so that I could present the case to my attending. I was engrossed in learning medicine, and in the challenge of being the best I could be at my job.

The day I walked into the CCU, I was about to start my last rotation of medical school.  I had matched into residency and was eager to graduate. Finally, I was at the end of one journey and ready to begin another. Unfortunately, my exciting transition from medical student to doctor had coincided with the swift decompensation of my stepfather’s congestive heart failure. After a surprising initial diagnosis only three years prior, my 48-year-old stepfather now had an ejection fraction of only 10 percent. He was now on the heart transplant list.

My mother and I rode up in the elevator together. On my first steps inside the unit, I was stricken with an odd sense of familiarity when I saw what were (clearly) residents and interns sitting at the nurse’s station. I felt a kinship with them; somehow I was already comfortable in a CCU I had never set foot in before. I instinctively used the hand sanitizer dispenser before entering my stepfather’s room. I greeted him with a big smile and a hug, surprised by how much color he had in his face.

He didn’t fit the picture of a unit patient, at least not the ones I had seen. He was laughing and talking, and had his Kindle next to his bed. It was odd to see a monitor next to him and a catheter protruding from his neck. My eyes instinctively scanned the room and noted all his vitals and pressures, and what bags were hanging.

I sat and talked with him and my mother for a while.  He told us that a few hours prior to our visit, his transplant coordinator had told him he might be getting a heart in only a few days. While this was a cause for celebration on many counts, it was also a cause of unbridled fear.

My stepfather is the type of man who had always taken care of himself. He was an avid skier. He loved rock concerts and going in the ocean. He loved roller coasters, and traveling. He was always looking for the good in people. He had a strong relationship with God.  When he met my mother, she had just divorced from my father after 22 years of marriage, and he worked hard to be a real part of our family. He helped me move home from college and then across the country to medical school in Florida. He visited me often.

Since he had been diagnosed, all the things he had loved got taken away from him, one by one. Over the course of only three years, he had lost his ability to work, was no longer allowed to go on roller coasters, and was too tired to exercise or travel. He was too weak to go in the ocean, and couldn’t visit me in Florida anymore. Rock concerts came with the stress and anxiety of walking to his seat. By the time I visited him in the CCU, the only thing he was able to do at home was light cooking or cleaning. And that was on a good day.

The thought of a heart transplant had challenged his relationship with God. He had called me on the phone, crying, on the occasions when anxiety attacks would remind him that he was too young to die. He told me that he wasn’t afraid of what would happen to him when he died, but that he was sad and scared to leave my mother behind, and couldn’t believe he would never get to meet my children. He told me that sometimes he thought to himself, in the dead of night, that it might be easier if he were to go to sleep and just not wake up; that the struggle to breathe was just too much, that he felt like he was drowning.

On that day in the CCU, we celebrated our newfound hope for transplant, but we realistically talked about the fact that the post-operative course would be very long and hard. He told us he was afraid of waking up on the ventilator. He shed tears when he told us that he was sad for them to take out his heart and give him a new one.

“That’s my heart,” he cried, “I was born with it.”

As physicians, we learn to separate ourselves from the lives of our patients. I would actually like to say that this is intentional, that doctors emotionally distance themselves from their patients because they would not be able to function as clinicians if they stayed connected. However, I believe something much worse to be true. I believe that it happens naturally.

Somewhere in my third year of medical school, I crossed a threshold where I began to see my day in terms of completing tasks on my patient lists. While I learned to give comforting words and foster hope, I had also learned to disconnect. I had learned to tell one man he is dying, and then walk ten steps, smile, and introduce myself to the man in the bed next to him. It had begun to feel somewhat like an assembly line of patients, order sets, and progress notes.

When I began medical school, I had thought that I would have to try hard to turn off my feelings. I realize now that in order to be a good doctor, I need to intentionally turn them on.

When my stepfather finally got called for a heart, I happened to be home. I accompanied him and my mother to the hospital in the middle of the night.  I watched in horror as they told him they had accidentally misplaced his advance directive, and verbally asked him each question on the document in order to make a new one right before the surgery. The anesthesia consent was equally terrifying, as they made sure he understood every possible eventuality of the surgery, including death. As the resident left the room, my stepfather chanted under his breath to himself “If I don’t do it, I die anyway … If I don’t do it, I die anyway …”

When transport came, he and my mother began to cry. As they took him down on the gurney, they asked him to identify himself and state what procedure he was having done. Voice shaking, he stated his name, and that he was having a heart transplant. Holding his hand before they wheeled him away, my mother and I told him soon he would be asleep and wouldn’t remember a thing.

Unfortunately, the surgery did not take place. It turned out that the donor had an unknown tumor in the thorax, and they couldn’t transplant the heart. My stepfather was already under anesthesia when the tumor was discovered. When he awoke, thinking the surgery was over, he was told it had not happened at all.

Later, in the CCU, he was having anxiety. His nurse leaned over his bed, annoyed, and asked condescendingly “are you usually a worrier?”

My pre-medical school self was horrified. My medical school self was not surprised at all.

I am thankful that I have had the opportunity to be back on this side of the curtain. I had forgotten what it feels like to be the patient or family. The heart I had before medical school had been replaced with one that beat only in response to good grades and getting right answers. I want my old one back.

Tonight, my stepfather is on his way to the hospital after being called for a heart the second time. I am hopeful this time the surgery happens and goes well. While I wait for good news, I can’t help but reflect on what I can learn from this experience. I find myself making a vow.

From this point on, I will try to see my patients through the eyes of their families. I will ask the important questions, and I will listen to the answers. I will remember that my words hold meaning and that I can scare or inspire, offer hope or sometimes just listen.  I will make a concerted effort every day to not only do my job well, but to consciously do my job with love.

Angelina Somoracki is an internal medicine resident.

Image credit: Shutterstock.com

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