Abigail Schirmer - Patient Centered Ethics: Pathography

Jan 21, 2022 at 08:28 pm by pj


Familiar Fears

      I thought had my entire career planned out, until my 3rd year general surgery clerkship.

      I learned more than I ever imagined I could as a medical student during six weeks in DeLand, FL— lessons of surgery, medicine, patient care, airplanes, life, and even myself. Unexpectantly, my “perfect” plan changed for the better because of two general surgeons and one, life changing, patient.

      This one patient, ironically, had nothing particularly abnormal or complex about her case. She presented with fear and abdominal pain. Symptoms started earlier that morning when experiencing a horrible pain in her lower abdomen after lifting a heavy object. This elderly woman, mother, church-goer, and friend appeared much younger than her stated age. She had no history of health issues, making this a terrifying event for her. After episodes of vomiting, she came to the hospital because she was afraid it could be something serious, which would require her biggest fear—surgery.

      It was my first week of the clerkship. I met her on admission, with NG tube vigorously draining and remarkable concern on her face. It was a look of concern and fear which I knew all too well.

      You see, at the beginning of medical school, I got sick. Not just any cold or flu- I fell ill with a rare medical condition. The fear which accompanied those moments of uncertainty, was something I tackled head on, all while trying to learn medicine as a 1st year student. There was a steep learning curve in handling this mode of fear and adversity, but with support and resilience, I overcame facing the unknown and I hope to utilize my experience to help others face theirs. I attribute part of this resilience to my own grit, but the other part to my hematologist who showed me how effective empathy can be in helping patients feel cared for. Learning empathy became a driving, and distracting, factor as I returned to my healthy self. Now on rotations, I could finally practice it.

      Like my hematologist did for me, I attempted to ease her fears and comfort her in a time where she did not have any family locally. We discussed how she was feeling and talked about why she was concerned—she needed someone to listen. We conversed over details of her life and family, not pertaining to her prognosis, but significant to her healing—I knew this once helped me.

      At the time, I didn’t think my efforts were any help to her care. I thought, what could a medical student possibly do to help? After interview, examination, and imaging, it was determined she had an incarcerated hernia. I watched my attending ease her fears of surgery effortlessly, noting how he was able to connect with a stranger in a matter of minutes, as we told her of the need for urgent repair later that afternoon.

      As we scrubbed for the case, my attending inquired my field of interest. I adamantly relayed my career plan, “I’m going to be an anesthesiologist”. Little did I know how this would change, and how pivotal this moment truly was.

      The patient tolerated the procedure well and the hernia was repaired with no signs of bowel ischemia. In the PACU, we told her everything went well. The face once surmounted by fear, was resolved with relief. Over the next days, we removed her NG tube, she tolerated PO intake, and was successfully discharged with immense gratitude.

      On my third week of the clerkship, I was excited to see her in outpatient post-op clinic. We talked about how well she was recovering; amongst other things, as we had established a relationship through the time she was in the hospital. I told her I was very happy to see she was feeling better. She took my hand, looked me in the eye, and thanked me for “just…caring.”

      At this point, I had a lot going through my mind. I could never develop a relationship and empathize with patients if I followed through with my original career plan. I recognized I could never quickly fix the problem through operation, if I wasn’t a surgeon. Did I need to revisit the “perfect” plan I once had in mind? I prayed for a sign for which path I should choose.

      On the fourth week of my clerkship, I received a text, “You’ve Got Mail!”. Alongside it, a photo of an envelope addressed to me. It was a letter written to me from the patient I had cared for.

      I fought back tears as I read this letter, recognizing I have written similar words to physicians who cared for me. She wrote how she sensed that I have compassion much like my surgery attending, and it meant a lot to her to be cared for in that way. She wrote she would “pray for success in my medical career so that other patients would experience the same care that my attending and I afforded her.”

      This letter was clearly that sign I prayed for. It was in this moment, because of the relationship with this patient, I choose to pursue a career in surgery.

      Before starting rotations, I set an intention to care for patients in the way I have been cared for and the way I’d want my family to be cared for. I hope this intention resonates with my future patients the way it resonated with this individual. She taught me the importance of practicing empathy even when it doesn’t feel effective or helpful—even, if I’m “just” a medical student.

      In my final week, one of my attendings told me a quote that I carry with me every day: “It ain’t what you don’t know that gets you into trouble, it’s what you know for sure that just ain’t so.” I thought I knew what my calling was for nearly six years, but it just wasn’t so.

      Two exceptional general surgeons and teachers, a relationship with one grateful patient, and a heartfelt, handwritten, letter showed me which path I was meant to take. I owe much of my future career to the influence, teaching, and guidance these surgeons provided and to the opportunity this patient gave me to practice and share empathy in the face of a familiar fear.











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