As a fourth year medical student I did my “sub-internship” in oncology. I hoped that this rotation would help me choose what specialty to pursue: internal medicine or psychiatry.
One of “my” patients was a woman with breast cancer that had spread to her liver and lungs. Fluffy brown hair fell to her shoulders. Wrinkles surrounded her puffy eyes that held jade green irises. Though she was in pain, she was patient and kind.
On the evening of her second day in the hospital, I came to her room and asked if there was anything else we could help with that day. Her pale, thin lips stretched into a sad smile.
“No, thank you,” she answered. “Have a good night.”
“I’ll see you tomorrow,” I said.
She was sleeping when I saw her the next morning, though awoke without a startle when I said her name. She kept her eyes closed as I placed the cool, metal diaphragm of the stethoscope on her chest and back. She murmured her thanks before I left her room.
As the attending oncologist, resident, intern, nurse, fellow medical student, and I approached her room later for formal rounds, she called to us.
“I can’t see!” she gasped. “I can’t see!”
We surrounded her bed and the attending began to ask her questions. He waved fingers in front of her face. He directed the beam from his penlight into her eyes.
“I can’t see! No, I can’t see!”
“But you could see yesterday, right?” he asked. She turned her head as if she was looking around at us, but her gaze was over our heads.
“Yes… but I can’t see now. Does this mean that I will never see my husband and daughters again? Is this permanent?”
I tried not to cry. The other medical student and the intern also looked away, their eyes welling with tears.
We learned later that the cancer had metastasized to her occipital lobe, the part of the brain that controls vision. Though her eyes were in good working order, the part of her brain that interpreted the electrochemical signals from her optic nerves was not. The cancer had stolen her sight.
You learn a lot of things in medical school: anatomy, physiology, pharmacology, and other concrete facts about human function. You also learn about human relations, communicating with people with different agendas, the system of health care, and other topics that fall under the “informal curriculum“.
You also learn how tenuous life is. You see women give birth to dead babies. You see children succumbing to cancer. Healthy adults get hit by stray bullets and drunk drivers. Heart attacks and strokes steal time and life away without making a sound.
You begin to recognize the blessings that you previously overlooked: I can eat all the cookies I want and I don’t have to take insulin. I don’t need a walker to get around. My fingertips and toes can feel the soft fur of a cat, the hot water coming out of the shower, and the zing of static electricity. I can breathe without difficulty and without having to lug an oxygen tank around. My arms and legs move when I want them to. My balance is intact.
You also realize, with some dread, that all of that can change in an instant. So you better enjoy the blessings while you got ’em.
My mother was sent to the hospital with urgency the day I returned to California to visit my parents. She was subsequently diagnosed with metastatic lung cancer.
I am grateful that I could advocate for my mother while she was in the hospital. I am also thankful that I could translate what was happening—not just from English to Chinese, but also from medical jargon to plain English—to my parents.
I was struck by the degree of confusion and uncertainty throughout her hospitalization. Things that I knew as a physician were not at all obvious to my parents. Things that I knew as a concerned family member were not at all obvious to the physicians.
I was and remain humbled.
As a consequence of this, upcoming posts will focus on how health care in hospitals work, what hospitals can do differently to help patients understand what is happening, and things that both medical staff and patients can do to make the hospital experience better for everyone.