Learning Outside of Books

My internal medicine attending told me “there’s so much more to learn than just what is in your books”. This IM rotation has proven that time and time again. I would like to share:

I picked up a patient on my inpatient general IM rotation who was a 80something woman who came in for dehydration and AKI. Turned out she was in lactic acidosis due to a necrotic gallbladder and severe heart failure. My resident asked if I wanted to lead a discussion with the patient, and later her POA, about her code status. It was so much more difficult than I ever could have imagined. I turned their world upside down – she was just dehydrated and now we’re sending her to inpatient hospice? Walking through it for the first time with my resident there for backup was definitely an incredible learning experience in how to break bad news to patients, and then being with them every step of the way until she was transferred to hospice. Nothing will ever make me forget the tearful hug her husband gave me when they left thanking me for taking care of his wife better than he could at that point.

It seems, unfortunately bad news is going to be something I deal with quite often. I’m on a rotation in Michigan and am working on a general medicine service, but it is on the oncology floor – so we take care of everything but the chemotherapy regiment for patients. We have young patients who just recently found out their abdominal pain was metastatic adenocarcinoma and are starting chemo, patients who just found out they have a brain tumor, and everything in between. These cancer patients cease to amaze me. They are so strong and even though they feel awful they greet you with a smile every day. Today when I came in to see my patient who got their diagnosis a week ago she was vomiting from the chemo. She washed her face, came and sat on the bed, and smiled and wished me a good morning. Good morning! I asked how she was doing and if we could make her feel better in any way. After we talked for a while she told me that life is too short to be anything but happy, hopeful, and full of love for life.

Life in the hospital is never the same from day to day, but one thing will never change – the patients will always be the greatest teachers. No textbook can ever teach you how to connect with patients or how to have hope even when you’re told it’s hopeless

So, like my patient said – BE HAPPY, HOPEFUL, AND FULL OF LOVE!