The importance of being there for your patients

Halfway into my four-week hematology consults elective at the county hospital during my fourth year of medical school, I was surprised that one of my patients was a 25-year-old woman from Romania — exactly my age. This was highly unusual, as most of the patients I had seen on this service were not this young, especially with a malignancy.

What was even more unique was that she had just arrived from Romania, where she had first developed acute lymphoblastic leukemia (ALL) as a young teenager. She was treated, but she relapsed five years later. After subsequent treatment, she relapsed again. And finally, after a bone marrow transplant, she relapsed once more. After she exhausted all treatment options available in Europe, her doctors recommended she try the United States as a final resort.

We met at her hospital bed, with her attentive mother beside her. As I introduced myself to both of them, I immediately saw we could relate. With a young, friendly face and a gentle smile, she answered all the questions I asked with a calm demeanor. Her mother did not understand much English, and she would talk to her in Romanian and interpret for me. She had visited two previous hospitals in the city just one month before I saw her at this county hospital. I was curious why — it turned out she was unable to afford the novel treatments at these hospitals, and hence she came to the county hospital. “My mother and I will fight this to the end,” she vowed.

But the imaging showed widespread involvement in her abdomen. She needed a miracle drug, some of which are currently being manufactured, but the county hospital did not have access to these. We could only give her more traditional chemotherapy. For someone so young who had fought for so long, it was disappointingly not much more than palliative care at this point.

As I continued to pre-round on her in the mornings and provide updates in the afternoons, we noticed much in common. We were both an only child in the family, we loved science and technology, and we were medical students aspiring to become oncologists, merely in different continents. We discussed the process of how medical school and residency worked in our homelands. We looked at photos of her memories from home and medical school on her phone. She taught me how to say some simple phrases in Romanian. Miss Z and her mother always enjoyed these short uplifting conversations while I provided treatment plan updates.

After the hematology rotation ended, I became a sub-intern (sub-I) on the wards service at that county hospital. I continued to visit Miss Z and her mother often. Miss Z and her mother stated they still looked forward to seeing me come say bună (hello), since all of their friends and family were still in Romania. As I was no longer part of her health care team, I could divert our conversations away to more lighthearted topics that could make us smile.

But the chemotherapy-induced complications, with the leukemia not responding, were taking their toll on her. Miss Z and her mother remained steadfastly hopeful that she would still somehow overcome this. The hematologists advised them to return to Romania, to spend her final days with family and friends, but they courageously decided to stay to keep on fighting against the ALL.

Unfortunately, she was eventually moved to the medical intensive care unit. The cancer and opportunistic infections were taking over. I finished my sub-I rotation, but I had one more elective at the county hospital. I would continue to stop by at the end of the workday. She was now too weak to move much or to talk for more than a few minutes. Yet I garnered much respect from her strength to never give up and to remain hopeful, along with her mother’s continued perseverance by her bedside.

One Monday afternoon, I went by her ICU room, and I noticed emptiness. The ICU resident told me she had passed away over the weekend; despite full efforts to resuscitate her, her heart having gone into unrescuable fibrillation. The previous week had been my final la revedere (goodbye). I refused to accept it for a moment, even though we expected this since day one of her admission. I never saw Miss Z or her mother ever again. I could only imagine her mother’s agony while watching her only daughter being futilely resuscitated, as she had never given up hope on her chance of remission.

No lecture in medical school could have ever taught me this, that simply bringing my presence, and a lighthearted conversation topic could brighten up the ICU room. Nor could any lecture prepare me for how to deal with the anguish of this inevitable news, despite what we had learned and experienced for three years in medical school. However, looking back at the positive vibes I was able to bring several times a week to her bedside, this was the ultimate meaningful experience for a medical student. In the environment where learning diseases, performing clinical duties, and studying for standardized exams often take precedence, I was no longer just that one medical student to Miss Z and her mother. I had become a friend supporting her battle to the end.

Albert Jang is an internal medicine resident.

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