From the outpatient clinic, an elderly female is directly admitted to the inpatient medicine service for chest pain and fatigue. By the next afternoon, the patient is diagnosed with bilateral pulmonary emboli (PE), requiring anticoagulation with heparin. Within hours of starting my 28-hour call shift, the patient develops an acute gastrointestinal bleed with worsening clinical status, needing a blood transfusion. Despite the new bilateral pulmonary emboli, the heparin must be held in hopes of preventing further bleeding.
For seasoned internal medicine physicians, this patient presentation is clinically complicated, but not overly daunting. Contrarily, as a brand-new intern, my mind careened from one thought to another like a game of table tennis. “I need to stop the heparin… but what if the PE gets worse? No, if the heparin stays, the bleeding will continue…” As orderly chaos envelops my intern-level brain, illuminating my imposter syndrome like a theater spotlight, my patient is battling her own fear and insecurity, sitting in a dim hospital room while staff pace in and out, hooking her up to machines and fluids she is not familiar with.
Throughout the evening, I enter the patient’s room, carrying the results of a new CT, lab or EKG, most of which are not favorable. Each time, I sit with the patient alone to explain the results and what next steps of management consist of. Just as the patient’s clinical status progressively declines, so too does her emotional well-being. Initial shock from diagnosis of the PE, hesitancy with starting a blood thinner, worry over the GI bleed, and overt fear of stopping the heparin — all are emotions sequentially experienced by the patient. Whatever sense of overwhelm and concern I feel could only be exponentially heightened in my patient. Thus, I decide to sit with her, alone, in her dim hospital room, as the wall clock ticks toward 1:30 a.m.
With tears watering her eyes and redness coloring her sclera, the patient speaks of her fear and anxiety. While superficially her fear centers around the worsening of clinical status, the true source of fear lay in the unknown, the unseeable future. Would she survive the hospitalization? Would she see her grandchildren again? These thoughts enveloped her mind, weighing down her spirit. Early that morning, the patient simply went to a standard doctor’s appointment, yet now she lay in a hospital bed, receiving an urgent blood transfusion with telemetry tracking her heart rhythm. The finite nature of life became real for my patient, quickly. My patient was standing face-to-face with the possibility of death, its uncertainty, its unforeseeable approach, and unknown timing. No treatment could quench this fear, so I held her hand and stood by her side on the ship’s bow, as it plunged into the storm. As an intern, there are many things I do not yet know how to do, but one thing I can do: be present with my patient, hold her hand, and chat. That is medicine.
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