It was the year Twitter launched, the Human Genome Project published the final chromosome sequence, and the FIFA World Cup competition saw Italy victorious.
I was graduating from an Emergency Medicine residency program. My life was good; I had proclaimed as much during my graduation dinner. When it was my turn to give a speech—I was clad in a fitted bright cocktail dress— I asked, “Don’t I look fabulous?” I said these words to a roomful of colleagues with whom I had worked thirty-six-hour shifts, all of us garbed in loose scrubs held at the waist by a drawstring. We had been powered by conviction, commitment and caffeinated beverages. They had seen me with crud in my eyes, dried drool at the corners of my mouth, and hair following its own direction.
At the dinner, we were all cleaned up, appearing new and shiny, excited about our futures. The room also held my mentors, my professors and my grey-haired department Chair. They loved what I said. They understood all I meant. They knew a resident’s journey: it had once been theirs.
I moved to Atlanta and started my new job. So much of medical training involves delayed gratification. We accrue debt, and we strain our neglect personal relationships. A child could be born, walk, talk, finish pre-K, kindergarten and first grade and we could still be wearing the short white coats of a doctor-in-training.
I had arrived at the place I had been fighting to get to, where I could claim full qualification in my chosen field and practice my specialty independent of the supervision of an attending physician. I was the attending. If I glanced over my shoulder in search of someone wiser and more experienced, there would be no one standing there. I was the doctor others now looked to for help.
An elderly patient and her family were looking to me. I had been in my new role for a month when this woman, with a crown of grey hair and dressed in a hospital gown she somehow made elegant, became my patient. She was struggling to breathe, so she needed to stay upright. I sensed that she tended to her posture regardless of how she was feeling, just as she paid attention to other aspects of her life.
When I shook her hand, I saw that her nails were newly manicured, the polish a neutral color. Her clothes were neatly folded beside her, as if she intended to leave the hospital just as impeccably as she had entered it: without a wrinkle.
The woman’s daughter and another family member were at her bedside. It is the daughter I remember. She was a nurse and she engaged me as a fellow medical professional, offering a concise summary of her mother’s medical history and current issues. Her mother nodded in the affirmative, grateful that someone could speak in her stead.
My patient did her best to inhale deeply as I listened to her lungs. I heard the wheezing I expected to find, given all that her daughter had told me. This was an exacerbation of her asthma, and the next steps were clear: chest x-ray, breathing treatments, steroids, reassessment for improvement. Of course, we would also run additional tests to rule out other conditions that could mimic an asthma flare. The woman smiled her assent. Both she and her family were comfortable with the plan.
Unfortunately, her symptoms persisted. She stumbled toward getting better, like a child learning to walk and falling frequently. I remember listening to her lungs and the wheezing was gone, but it would soon return. The radiologist reported that her chest x-ray revealed nothing acute, the type of picture expected in a patient with a simple asthma flare. No pneumonia, no collapsed lung, and no visible problems. I pulled up her chest x-ray and reviewed it. I agreed with the written report: there were no red flags. I told my patient and her family as much.
“I would like to keep you in the hospital overnight,” I said. “You just might need some extra time to get back to breathing well.”
She smiled at me the way a parent smiles at their child when they are going to deny a request. She had no intention of staying, she made that clear. She wanted to be in her own bed and around all that was familiar to her.
“I understand,” I said, even though I did not. I had never been hospitalized. I had no pulls elsewhere that would cause me to ignore medical advice.
“Let me give you another treatment, then we’ll talk again,” I said. Stepping out, I motioned for her daughter to join me.
“She lives with you. Maybe you can convince her that staying is the best choice?”
“I live with her,” she corrected, laughing. She was not being difficult; she was just letting me know how things worked. “What Mama says is what goes.”
Maybe it was because I was new at this. Maybe it was because I saw this patient as a delicate heirloom teapot and I did not want to be the hands in which she broke. Whatever the reason, I kept asking her to stay, and her answer was always the same: a polite no.
Eventually, she took off her hospital gown and got dressed. There were no wrinkles in her clothes, and her gait was steady as she walked out of the hospital.
“Hey, remember that patient you discharged yesterday?” my colleague asked as I arrived for my shift. With my bag still slung over my shoulder, I had not even unpacked my stethoscope, pen, or pocket pharmacopeia.
“Which patient?”
She swiveled her chair to face me. “The elderly one with asthma,” she said loudly. I could hear her. Everyone else could, too. “She’s back with a pneumothorax. Looks like radiology missed it on the chest x-ray.”
I had the sense that she wanted to say you missed it. I had not been at this job long enough to dislike anyone. Now I had.
I pulled up my patient’s chest x-ray from the previous day. There it was: a small pneumothorax. Air had leaked into the space between her lung and chest wall, causing it to slightly collapse. When she breathed in, that lung did not fully expand. I had missed this evidence of her struggle against air trapped in her pleural space.
I avoided her room, like a driver steering clear of a pothole. I did not check in on her to ask how she was feeling. She was being cared for by another doctor who was taking the requisite steps. The pneumothorax was small enough to be treated with a pigtail catheter, a less invasive option than a large chest tube.
Her daughter sought me out. “I want to thank you for taking such great care of my mother.”
“You know I missed a pneumothorax, right?” Given her medical background, I found it easy and necessary to be direct with her.
She brushed it aside with a sweeping hand motion, which told me she understood. And then she said, “You really looked out for her. You kept coming back and checking up on her.”
She had a way of speaking that was almost musical, with highs and lows. I felt as if she were literally and figuratively singing my praise.
I did not think I had done anything special, but I was thankful for her kind words. I took them and held on to them.
My time with this patient, and many others like her, could have taught me the importance of personalized care. However, it was not until I was sitting in my oncologist’s office, a decade-and-a-half after I had proclaimed how good my life was, that I understood what it meant to be well cared for by a medical provider.
I was the patient.
I had felt no lump in my breast. I had no family history of breast cancer. I had done my annual mammograms religiously and had always had normal results. Ironically, the year I was late for a screening was the year malignant cells decided to wreak havoc in the organ that had once nourished my children. At the time, I was embroiled in an acrimonious divorce and international custody battle. I had delayed my mammogram because my world was pulling me in many directions and there was always something that seemed more important to do.
My doctor did not know the complexities of my life because I did not divulge them. She did not know that breast cancer was just one of my many problems. She did not require this insight to care for me.
My doctor was who I needed her to be. She sat close. She let me cry. She passed me tissues. She validated my every emotion. In that room, I felt her full presence. I was like a traveler lost in a storm; she was the guide who knew the terrain. She had walked with others; she would journey with me.
What the poet Maya Angelou said is true: people will forget what you said, people will forget what you did, but people will never forget how you made them feel.
In my experience, it does not take much to illuminate someone’s path or to cast a shadow upon it. We can decide to compliment or chastise, to connect or withdraw. These decisions will determine how we will be remembered; these choices will sing our praises long after we are gone.
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