Joseph Rudy - Patient Centered Ethics: Pathography

Jan 21, 2022 at 08:18 pm by pj


One of the special aspects about being a medical professional is not only treating/diagnosing patients but also the ability to know individuals during some of the most private and memorable events in their lives. This past year, I was able to experience the highs and lows of medicine. From the pure elation of helping deliver a healthy baby, to also being present when life altering diagnoses or events were broken to family members. Throughout my third year of medical school, I had the privilege of being a part of many intimate moments in patients’ lives.

      One patient that was incredibly memorable was during my internal medicine clerkship. I first met her while on rounds with my attending and her husband was requesting her to be discharged. AB was an 82 y/o female with PMHx of lung cancer on chemotherapy s/p radiation, CHF, a fib, COPD and HTN who presented to the hospital with shortness of breath. As a medical one liner, one can tell she was a sick patient. While reviewing her chart, I found that AB had been recently hospitalized two weeks ago for a similar episode. During rounds we talked with the patient’s husband, and it was clear that health literacy was a large barrier. After multiple conversations, we were able to explain why she was in the hospital and how we can optimize her so she can be stable. He was grateful for us spending the time to explain all of this. AB was weak, breathing on oxygen and unable to speak in full sentences. Two days later she was subsequently discharged. She went home despite us urging her to go to rehab or physical therapy.

      After a few days I had forgotten about AB and returned to the busy hospitalist schedule with 15- 20 plus patients on our case load. Just before our shift ended, my attending had me go see an admission in the emergency department. Patient was an elderly lady with shortness of breath. After being in the hospital for 10+ hours and having been assigned to read several topics at home, I was not excited for another admission. I walked down to the ED and saw AB with her husband. My mood completely changed. AB was not doing well and was extremely short of breath. I immediately let my attending know and took a full history and physical from her husband while she chimed in at times. I still remember the look of her husband’s eyes and him pleading of why this is happening. I attempted to reassure him and the patient. Luckily my attending came in and we soon admitted her to the intensive care unit. We put in some orders, placed her on BiPAP and were reassured from the nursing team when hearing that her O2 stats improved.

      I pre-rounded on AB the next morning in the ICU and her husband was still at bedside. I learned that she had to be on pressors last evening, but they are slowly weaning them off. The nursing team was hopefully optimistic. I saw AB and she was the best I had ever seen her since my multiple visits in her hospital rooms. After a brief conversation with AB and her husband, I was also cautiously optimistic. A few hours later I rounded with my attending and AB took a turn for the worse. Her husband, who normally looked panicked and scared, was calm and sad. He did not have any questions and we also did not have any answers. AB passed away later that evening. I learned the next morning after asking why she was not on our patient list. While I had seen patients pass away in the emergency department before, AB was the first death of a patient that I truly had gotten to know and care for.

     After this day, I took some time to reflect on my experience with AB, her husband and medicine in general. From a medical perspective, AB was a very sick patient who lived a long life. We optimized her medical care and did everything by the books. However, AB was not just another patient on our case load. She was a mother, wife and was loved by many. I realized that some of the hardest aspects of being a physician is taking the time to get to know your patients when time is finite. My experience with AB and her husband has further emphasized the need to explain things to patients in ways they can understand them. Spending an extra few minutes might make a world’s difference to a family member who might have no idea what is going on. As physicians, part of our duty is to comfort and console patients regardless of their situations.

      This past year, I have grown both personally and professionally. Clinically, I have learned (and let’s not overlook the many times I have forgotten) so much about various medical conditions, treatment plans and how medicine works outside of a textbook. On a personal level, I have been able to place myself in patients’ shoes and empathize with the very real ups and downs of life. As a future physician, I hope to always comfort patients during some of the most difficult times in their lives. I might not always be that bright eyed, enthusiastic, third year medical student, but I aim to never lose sight of the humanistic side of medicine.









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