On Being Nauseous

It was the end of my first week on Oncology, and I felt like throwing up.

Perhaps it was early in the morning, seeing the hospital patients I was following all having taken turns for the worse overnight. Or maybe it was seeing a daughter comfort her mother as she came to grips with learning she had months to live.  Or it was the look of regret on the face of a man who had quit smoking earlier in the year, only to be diagnosed with lung cancer weeks later. Whatever it was, I went home that night with knots in my stomach.

Suddenly, the humanity in medicine was all very real. For two years, my classmates and I had been through the avalanche of endless powerpoints and standardized exams. Even the “humanistic” portions of medicine had been broken down into standardized grading rubrics and multiple-choice format. When we applied to medical school, we wrote in our personal statements about wanting to be holistic and caring physicians and we spoke in our interviews about seeing the person, not just the disease. But through the rigors of non-stop exams and lectures, we began seeing only diseases.

As a survival mechanism, we approached these diseases as factoids, devoid of any human emotion. And capping off these two years was a six-week intensive preparation for our first set of board exams, a time dedicated to exclusive self-directed studying and devoid of normal human interaction.

Over that weekend, I struggled with thoughts of mortality, both of the patients I had seen and of my own. Most of all, I remembered their faces in the toughest moments. In their eyes, I could see the anxiety, fear, and uncertainty. Their personalities had become much larger than their diseases and the factoids I had learned about them.

On Going Home

The first day I met her, she wanted nothing to do with me.

With metastatic cancer spreading all over her body, the last thing she wanted to be was some medical student’s practice patient. How could I blame her? She reluctantly obliged and eventually laughed as I fumbled my way through the physical exam. Having been in and out of the hospital for the past few years, she had seen more history and physicals than I had by this point. Perhaps she felt sorry for me, which was odd given the circumstances.

Day after day, I came in to check in on her and eventually she smiled when I would wake her up at six in the morning. In between me asking about her shortness of breath and chest pain, we’d chat about how important her family was to her and she’d make fun of me for having a shorter white coat than all the doctors. But that was the first week. Over the weekend, her condition rapidly deteriorated and she barely recognized her husband at this point. A decision had to be made, pursue treatment and risk dying in the hospital or go home on hospice care.  She was able to go home on her terms and spend a few more days with loved ones.

On Keeping A Promise

“Cancer was the best thing to ever happen to me.”

Diagnosed with early-stage breast cancer on a mammogram years ago, she had been through the gauntlet of surgery, chemotherapy, and radiation. I met her in the clinic for her yearly follow-up visit, and her eyes widened when she learned I was a medical student. With a straight face, she said cancer was the best thing to ever happen to her. Ever since completing her treatment, she had decided to finally start checking off her bucket-list items. First on the list was learning to paint, something she had always admired but never picked up herself. Whipping out her phone, she went over a piece she had just finished. We briefly talked about her painting process and I told her about dabbing in art long before coming to medical school. As I finished up listening to her lungs and stomach, she grabbed my hand and made me promise I would take some time and learn to draw. And now on Saturday afternoons when I put down the charcoal and step back from a piece to gain some perspective, I think of her and the promise I made.

[Featured image via Flickr user Fernando Rodriguez]