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Last Thursday-A Day in Residency
7:40am:Checked my clinical tasks. There are a lot of them and most of them have red unhappy faces next to them. It’s going to take me at least two hours to get through those ugly little unhappy faces.
8:00am:I walked across campus to a symposium on health disparities organized by two of my fellow residents. The speaker was the very eloquent chief medical officer of the American Cancer Society, Dr. Otis Brawley. He both made me laugh and think differently about race, health disparity, and the politics of healthcare. He made me want to read again and relearn history through a new perspective. I felt empowered by my curiosity.
9:30am:Despite this being protected learning time, I could only stay for the first hour of the symposium. I had fifteen minutes to make it to city hall. My initial feelings of empowerment faded as I thought about health statistics and the misguided violations of human rights throughout history that have forced us revise our societal definitions of humanity. My empowerment turned to anger.
This is what I felt as I neared the lawyer’s office to sit in on, as an observer, the deposition of one of my favorite graduated residents. The deposition was her defense of her medical decision-making around the death of a patient we cared for together, as a team. I sat in silence, feeling her anxiety, feeling my own creeping anxiety, seething with resentment for the lawyer who looked like he was 25 asking her the same question over and over again using slightly different dialects of legal language.
12:00pm:I left the deposition after 2 hours for resident lunch. The lawyer was only about half way done with his questions.
Walking down Market street, I returned a call from a local hospitalist who admitted one of my patients, an Iraqi refugee mother with profound mental health and pain pathology. The doctor was struggling to understand what was wrong with her because she couldn’t find an answer in any of the imaging and testing she had done over the course of 4 hospital days. This patient is and will always be thought of as one of my most difficult patients. So relieved that the call went straight to voicemail.
Then I called my mom and all that anxiety began to seep out in frantic tears and quick, shallow breaths. My worst fears rising to the surface, facing the moment when I am exposed for the terrible doctor that I am. The moment when I have to defend my decisions during a 24-hour in-house weekend call that happened in the fourth month of my intern year over 2 years ago. The responsibility is Real. Keep It Together. I am accused of negligence. That is the word that stands out to me more than the twenty or so other accusations. It makes my heart ache, twists it up in a ball, a knot of resentment, anger, insecurity and profound sadness. Since that fateful call, I have spent thousands of hours working and contemplating the profound privilege and responsibility associated with caring for patients and neglecting the things that fill me with life.
Resident lunch. Rarely ordered salty Chinese food. I felt left out because I missed the rest of the symposium.
1:30pm:The afternoon begins. The last long roadtrip to the suburban nursing home, coming less than a week after a Mothers Day trip to see my nonagenarion grandparents. My grandfather fell during our trip. From the deck of the porch I was standing on, he looked like a baby on the ground, curled up in almost a fetal position, fragile and proud and vulnerable and bleeding.
We were asked to help with an admission beginning with the recording of the history of a different nonagenarion grandfather who fell out of bed and went to the hospital with hematuria. He got an MRI, kyphoplasty for a compression fracture of indeterminate age, a bone biopsy, and a blood transfusion. He went into the hospital able to dress and bathe and he was discharged to sub-acute care, after 10 days, completely dependent. His daughter’s goal was to have him back to baseline before he comes home.
He reminds me of my grandfather on exam, almost deaf despite hearing aids. I think of Jake and his genetic predisposition for hearing loss and the way he always asks me to turn up the television.
Ankles without cartilage supported by braces, sitting in a wheelchair. A stroke took away his left arm and his ability to walk 18 years ago.
When questioned, he looks confused, and calls out to his wife for the answer. But she died over five years ago. His daughter quickly changes the subject but the air had already become impregnated with the grief her father would experience in reliving this loss.
Our attending begins the code discussion and the daughter tenses. No machines. Chest compression? Cracked ribs that will most certainly meet a machine. The daughter is Not Sure, not ready to talk about it, sitting on the bed, the age of my parents but seemingly older to me, looking a little stunned–like she never truly contemplated the way her father was going to die. My grandfather is now frail. This makes my dad vulnerable. I thought of the fear of my dad falling off a motorbike on a dirt road in Uganda. Then I thought about Jake’s parents and the moment of his mother’s death. I considered what my grandparents must talk about at home. Do they talk about death? Do they share their fears with each other? They have lived a life together and now they are dying together in the slowest way possible. The room felt warm and I was ready to go.
4:45pm:I escaped from the car into the bright sun a couple of blocks away from my house. Everyone was out. It was a beautiful Spring night. Home early to sit on the roof in the treetops watching the sunset across the cityscape, the colors of the leaves changing with the day’s last exhale of hazy voluptuous purple light. I experienced a moment of deep respect for nature and then a deep appreciation for the complexity inherent in the profession of medicine.
And then my final moment of deep appreciation for the fact that Jake was on his way home.
Globe Napper 