The smallest human acts can have a lifetime of impact


My dad died on May 11, 2003. It was Mother’s Day. I was 18 years old. Those are the easy facts. The more difficult ones are those detailing the events that led to his death. My dad was so many things — a brilliant geologist, a loving father, an inventor, a pilot, and a Vietnam veteran — to name a few. He survived three tours on the front lines in Vietnam, but he didn’t come out unscathed. He was a victim of post-traumatic stress disorder and, subsequently, progressive alcoholism. Despite numerous attempts by my family to help him, and treatment in every form imaginable, we watched a truly amazing person become engulfed in a vortex of pain and sadness. One night he fell. There was intracranial bleeding, seizures, and then irreversible hypoxic brain injury. It was traumatic, unexpected, and life-changing for me and many others.

Memories and questions

I started residency more than 10 years later. Just like every other resident, I spent busy days and nights in the hospital caring for countless patients with umpteen ailments. I also spent a lot of time working in the ICU. Unsurprisingly, my ICU patients frequently triggered recollections of my dad’s last hours in a similar setting. I very vividly remember him lying on an ICU bed connected to a ventilator. He was slightly turned on his left side, and had thick, white dressings around his head. I remember a nurse entering his room and quietly saying, “Tim, I’m going to give you some Tylenol now for your fever.” At the time I thought it was odd that she was explaining this to him. At 18 years old, I knew what “no meaningful brain activity” meant, and I knew she did too. But, at the same time, her gesture was comforting to me.

The more I cared for critically ill patients during residency, the more I started thinking about the providers who took care of my dad. I wouldn’t call it critical thinking by any means — more like nonchalant, stream-of-conscious thinking as I walked from one patient unit to another. I wondered, “Were there internal medicine residents similar to myself? Were they really tired? Was there a critical care fellow? If so, was he or she a jovial fellow? I hope so – I like jovial critical care fellows.” These random thoughts continued for years. But, the more I wondered, the more apparent it became that I actually didn’t remember any of the physicians who took care of my dad. The only person I remembered was the nurse who gave him Tylenol. Initially, this was a surprising realization. In a situation where likely countless physicians, residents, students, and therapists participated in my dad’s care, how was it possible that I only remembered one person?

Humans and answers

The answer actually came to me via Twitter. In a post on September 22, 2017, Mark Reid, MD (@medicalaxioms), wrote, “When you run out of doctor things to do for the sick person, see if there are any human things you can offer.”

Though seemingly simple advice, this resonated with me. It reminded my of my dad’s nurse. Due to the severity of his injuries after his accident, we quickly ran out of medical things to do. The nurse, however, still took it upon herself to do human things. The Tylenol she had to give was medically useless, but she used its administration as a venue to express care from one human to another. She called my dad by his name. She explained to him what she was doing and why she was doing it, and she didn’t judge his situation. Even her soft tone of voice was a much-needed juxtaposition to the chaos that had occurred up to that point. Even if it took me years to fully realize it, all of this mattered to me. Actually, it still matters to me now.

I’m sure that the other members of my dad’s care team were also great. I realize that circumstance and time likely also play large roles in my inability to recollect specific people at that time. However, I do think the concept of ‘doing human things’ is important to remember throughout medical training and practice. Our chosen careers often place us in a position of being participants in difficult, life-changing events of patients and their family members. We won’t always have the answers. Even when we do have the answers, we won’t always have the solutions. But, we can always be human. And, as I can attest, even the smallest human acts can have a lifetime of impact.

Karmen Wielunski is an internal medicine chief resident who blogs at Insights on Residency Training, a part of NEJM Journal Watch.

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